经食管超声心动图在检测二尖瓣疾病或非风湿性心房颤动患者左心房血栓及自发显影中的作用

Role of transesophageal echocardiography in detecting left atrial thrombus and spontaneous echo contrast in patients with mitral valve disease or non-rheumatic atrial fibrillation.

作者信息

Tsai L M, Chen J H, Lin L J, Yang Y J

机构信息

Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.

出版信息

J Formos Med Assoc. 1990 Apr;89(4):270-4.

PMID:1976743

Abstract

Instances of left atrial (LA) thrombus and spontaneous echo contrast were evaluated by both transthoracic echocardiography (TTE) and subsequent transesophageal echocardiography (TEE) in 50 patients with rheumatic mitral stenosis (Group I) and 52 patients with non-rheumatic atrial fibrillation (Group II). Among these 102 patients, TEE detected LA thrombi in 16 patients (15.7%) and spontaneous echo contrast in 35 (34.3%). In contrast, TTE revealed LA thrombi in only 8 patients (7.8%) and spontaneous echo contrast in only 2 patients (2.0%). All of the LA thrombi and spontaneous echoes detected by TTE were also found by TEE. When TEE was applied, patients with spontaneous echo contrast had a significantly higher incidence of LA thrombus than did those without this echo (42.8% vs 1.5%, p less than 0.01). Spontaneous echo contrast was coexistent in all but one of the patients with LA thrombi (15 of 16, 93.7%). In Group I, the incidence of spontaneous echo contrast for patients with isolated or predominant mitral stenosis was high (68.3%) when TEE was applied, but this echo was not observed in any patient who had more than a moderate degree of mitral regurgitation. In Group II, 7 patients (13.5%) were also found to have spontaneous echo contrast, which could only be detected by TEE. Of these 7 patients, LA thrombus was noted in 4 by TEE, but only in 1 by TTE. Thus, it can be concluded that: (1) TEE is superior to TTE for detecting LA thrombus and spontaneous echo contrast; (2) spontaneous echo contrast in LA is not only frequently encountered in mitral stenosis without significant mitral regurgitation, but is also found in some patients with non-rheumatic atrial fibrillation; and (3) the presence of spontaneous echo contrast is associated with a higher incidence of LA thrombus and may be considered as a warning sign for further formation of LA thrombus.

摘要

采用经胸超声心动图（TTE）及随后的经食管超声心动图（TEE）对50例风湿性二尖瓣狭窄患者（I组）和52例非风湿性心房颤动患者（II组）的左心房（LA）血栓及自发显影情况进行评估。在这102例患者中，TEE检测到16例（15.7%）LA血栓及35例（34.3%）自发显影。相比之下，TTE仅发现8例（7.8%）LA血栓及2例（2.0%）自发显影。TTE检测到的所有LA血栓及自发显影TEE也均能发现。应用TEE时，有自发显影的患者LA血栓发生率显著高于无此显影者（42.8%对1.5%，p<0.01）。除1例LA血栓患者外，其余患者均存在自发显影（16例中的15例，93.7%）。在I组中，应用TEE时，单纯或主要为二尖瓣狭窄患者的自发显影发生率较高（68.3%），但二尖瓣反流程度超过中度的患者未观察到这种显影。在II组中，7例（13.5%）患者也发现有自发显影，且仅能通过TEE检测到。在这7例患者中，TEE发现4例有LA血栓，而TTE仅发现1例。因此，可以得出结论：（1）在检测LA血栓及自发显影方面，TEE优于TTE；（2）LA自发显影不仅在无明显二尖瓣反流的二尖瓣狭窄患者中常见，在一些非风湿性心房颤动患者中也可发现；（3）自发显影的存在与LA血栓较高的发生率相关，可被视为LA血栓进一步形成的警示信号。