Acar J, Cormier B, Grimberg D, Kawthekar G, Iung B, Scheuer B, Farah E
Service de Cardiologie, Hôpital Tenon, Paris, France.
Eur Heart J. 1991 Jul;12 Suppl B:70-6. doi: 10.1093/eurheartj/12.suppl_b.70.
The purpose of this study was to evaluate various methods of diagnosis of left atrial thrombi (LAT) in patients (pts) with mitral stenosis (MS). From 1980 to 1990, 581 pts with MS have undergone open mitral commissurotomy (n = 169) or valve replacement (n = 412). All pts had transthoracic 2D echocardiography (TTE), 101 transoesophageal echocardiography (TEE), 192 a left atrial angiography (A) (from a left ventricular injection if associated mitral regurgitation grade 3 (n = 154) or from an injection in the pulmonary artery (n = 38) and 229 a coronary angiography (CA). Tomodensitometry (TD), nuclear magnetic resonance (NMR) and 111 Indium platelet imaging (IPI) were performed in some cases, 2, 8 and 5 respectively. All these examinations were carried out in the month before surgery. LAT was found by the surgeon in 43 pts (7%). The site was left atrial appendage in 26 cases (60%) and left atrial cavity in 17 cases. Sensitivity (Se), specificity (Sp) of TTE/TEE/A/CA were the following: TTE, Se% 28, Sp% 99; TEE, Se% 83, Sp% 97; A, Se% 28, Sp% 99; CA, Se% 14, Sp% 100. Specificity was high with all methods but sensitivity was high only with TEE and poor with other methods because of difficulty in detecting thrombi of the left atrial appendage. Specificity and sensitivity of TD, NMR and IPI require more information. False-negative cases are possible with NMR (1 case) and IPI (1 case) in well established LAT. We conclude: TEE is the easiest way to detect LAT, particularly when located in the left atrial appendage. It should be carried out systematically before percutaneous mitral valvuloplasty or surgery.
本研究的目的是评估二尖瓣狭窄（MS）患者中左心房血栓（LAT）的各种诊断方法。1980年至1990年，581例MS患者接受了二尖瓣直视交界切开术（n = 169）或瓣膜置换术（n = 412）。所有患者均接受了经胸二维超声心动图（TTE）检查，101例接受了经食管超声心动图（TEE）检查，192例接受了左心房血管造影（A）（如果伴有3级二尖瓣反流（n = 154）则从左心室注射造影剂，或从肺动脉注射造影剂（n = 38）），229例接受了冠状动脉造影（CA）。在某些情况下分别进行了体层密度测定（TD）、核磁共振（NMR）和铟111血小板显像（IPI），分别为2例、8例和5例。所有这些检查均在手术前一个月进行。外科医生在43例患者（7%）中发现了LAT。部位为左心耳26例（60%），左心房腔17例。TTE/TEE/A/CA的敏感性（Se）、特异性（Sp）如下：TTE，Se% 28，Sp% 99；TEE，Se% 83，Sp% 97；A，Se% 28，Sp% 99；CA，Se% 14，Sp% 100。所有方法的特异性都很高，但只有TEE的敏感性高，其他方法的敏感性差，因为检测左心耳血栓存在困难。TD、NMR和IPI的特异性和敏感性需要更多信息。在确诊的LAT中，NMR（1例）和IPI（1例）可能出现假阴性病例。我们得出结论：TEE是检测LAT的最简单方法，尤其是当血栓位于左心耳时。在经皮二尖瓣球囊成形术或手术前应系统地进行TEE检查。
