Cormier B, Vahanian A, Michel P L, Porte J M, Iung B, Dadez E, Acar J
Hôpital Tenon, Paris, France.
Eur Heart J. 1991 Jul;12 Suppl B:61-5. doi: 10.1093/eurheartj/12.suppl_b.61.
The aim of this study was to assess the value of transoesophageal echo (TEE) in comparison with transthoracic echocardiography (TTE) in selecting candidates and evaluating the results of percutaneous mitral commissurotomy (PMC). One hundred and ten patients (pts) were examined by TEE and TTE before PMC. PMC was not performed in eight pts who had a thrombus in the left atrium detected by TEE but not by TTE. Out of the 102 other pts, TEE was better than TTE in detecting mild mitral regurgitation (MR) (84 vs 38, P less than 0.01). Spontaneous contrast was only shown by TEE in 70 pts. On the other hand, planimetry of the valvular area was only possible with TTE. This technique was also better in the assessment of the commissural area. During PMC, TEE enabled the interatrial septum to be punctured in two pts. After PMC, MR was trivial in 49 TEE cases compared with 36 by TTE and was moderate in 20 TEE pts compared with 12 by TTE (P less than 0.02). Transoesophageal colour Doppler showed a trivial atrial shunt in 63% of cases vs 13% by TTE (P less than 0.01).A small atrial septal defect was found in 30 cases only by TEE, and a spontaneous contrast persisted in all pts but six with moderate MR. In conclusion, TEE provides useful information in the ultrasonic assessment of PMC in particular with left atrial thrombi, mitral regurgitation, and the post PMC atrial septal defect. However, both methods are complementary and only TTE enables calculation of valve area.
本研究的目的是评估经食管超声心动图（TEE）与经胸超声心动图（TTE）相比，在选择经皮二尖瓣交界分离术（PMC）患者及评估手术结果方面的价值。110例患者在PMC术前接受了TEE和TTE检查。8例患者经TEE检测到左心房血栓而TTE未检测到，未进行PMC。在其他102例患者中，TEE在检测轻度二尖瓣反流（MR）方面优于TTE（84例对38例，P<0.01）。70例患者仅TEE显示有自发显影。另一方面，仅TTE能够进行瓣膜面积的平面测量。该技术在评估交界区方面也更具优势。在PMC过程中，TEE使2例患者成功穿刺房间隔。PMC术后，TEE检查的49例患者MR轻微，而TTE检查的为36例；TEE检查的20例患者MR中度，而TTE检查的为12例（P<0.02）。经食管彩色多普勒显示63%的病例有轻微心房分流，而TTE为13%（P<0.01）。仅TEE在30例患者中发现小的房间隔缺损，除6例中度MR患者外，所有患者均有自发显影持续存在。总之，TEE在PMC的超声评估中提供了有用信息，特别是在检测左心房血栓、二尖瓣反流和PMC术后房间隔缺损方面。然而，两种方法是互补的，只有TTE能够计算瓣膜面积。
