Chen Xin, Sun Dandan, Yang Jun, Feng Wei, Gu Tianxiang, Zhang Zhiwei, Xiu Zongyi, Tang Li, Ma Chunyan, Wang Xiaobing, Cheng Yanbin, Li Nan, Liu Shuang
Echo Lab, Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.
Echocardiography. 2011 Oct;28(9):1003-10. doi: 10.1111/j.1540-8175.2011.01474.x. Epub 2011 Aug 19.
Mitral valve (MV) repair provides a better outcome in patients with significant mitral regurgitation than MV replacement. Valve repair requires a thorough understanding of MV morphology. Recently developed real time three-dimensional transesophageal echocardiography (RT3D TEE) can provide online acquisition and accurate information of cardiac structures. The study aim was to evaluate the feasibility and accuracy of using RT3D TEE to assess mitral valve prolapse (MVP) and chordae rupture for surgical planning purposes.
Fifty-six consecutive patients with moderate to severe mitral regurgitation due to MVP received two-dimensional (2D) TEE and RT3D TEE the day before operation. The accuracy of the assessment of MVP and chordae rupture by RT3D TEE was determined and compared with assessment by 2D TEE using surgical inspection as the gold standard.
The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 2D TEE in detection of MVP were 87%, 96%, 93%, 88%, and 95%, respectively, whereas those of RT3D TEE were 100%, 99%, 99%, 98%, and 100%, respectively (P<0.05 for all comparisons). The receiver operating characteristic (ROC) curve areas for assessment of anterior leaflet and posterior leaflet segment involvement using RT3D TEE (ROC areas 0.96 and 0.99) were higher than for those using 2D TEE (ROC areas 0.86 and 0.94). Interobserver agreement for RT3D TEE (κ=0.97, 95% confidence interval [CI] 0.92-1.00) was significantly greater than for 2D TEE (κ=0.89, 95% CI 0.81-0.93) (P<0.05).
RT3D TEE is a feasible, accurate and reproducible method for evaluating MVP and chordae rupture in the clinical setting.
对于有严重二尖瓣反流的患者，二尖瓣修复术比二尖瓣置换术能带来更好的治疗效果。瓣膜修复需要对二尖瓣形态有透彻的了解。最近开发的实时三维经食管超声心动图（RT3D TEE）能够在线获取心脏结构的准确信息。本研究旨在评估使用RT3D TEE评估二尖瓣脱垂（MVP）和腱索断裂以用于手术规划的可行性和准确性。
56例因MVP导致中重度二尖瓣反流的连续患者在手术前一天接受了二维（2D）TEE和RT3D TEE检查。以手术检查作为金标准，确定RT3D TEE评估MVP和腱索断裂的准确性，并与2D TEE的评估结果进行比较。
2D TEE检测MVP的总体敏感性、特异性、准确性、阳性预测值和阴性预测值分别为87%、96%、93%、88%和95%，而RT3D TEE的相应值分别为100%、99%、99%、98%和100%（所有比较P<0.05）。使用RT3D TEE评估前叶和后叶节段受累情况的受试者工作特征（ROC）曲线面积（ROC面积分别为0.96和0.99）高于使用2D TEE的情况（ROC面积分别为0.86和0.94）。RT3D TEE的观察者间一致性（κ=0.97，95%置信区间[CI] 0.92 - 1.00）显著高于2D TEE（κ=0.89，95% CI 0.81 - 0.93）（P<0.05）。
RT3D TEE是在临床环境中评估MVP和腱索断裂的一种可行、准确且可重复的方法。
