Department of Pediatrics, Research Training Group 1126, Heidelberg University, Neckarstaden 18, 69117 Heidelberg, Germany.
Anesth Analg. 2013 Feb;116(2):287-95. doi: 10.1213/ANE.0b013e318262e154. Epub 2012 Jul 13.
Successful surgical repair of a regurgitant mitral valve (MV) is dependent on a comprehensive assessment of its complex anatomy. Although there is limited evidence of the feasibility and accuracy of intraoperative real-time 3-dimensional transesophageal echocardiography (RT3DTEE) in MV surgery, its use is increasing worldwide. We designed this prospective observational study of patients with mitral regurgitation to test initial findings on the accuracy of RT3DTEE images in the diagnosis of MV prolapse and chordal rupture relative to 2D imaging and to assess the potential of RT3DTEE for visualizing leaflet clefts.
TEE-certified anesthesiologists examined 62 consecutive patients undergoing MV surgery by acquiring a full standard set of 2D TEE sections and 3D zoom recordings. Offline, 2D and 3D images were presented independently and in randomized order to 2 expert interpreters. Accuracy was determined using the surgical findings as the "gold standard."
Surgical inspection identified 52 cases of MV prolapse (MVP). RT3DTEE correlated stronger with the surgical findings than 2D TEE for detection and localization of MVP (difference in proportions=33.9%, P<0.001) and chordal rupture (difference in proportions=25.8%, P<0.001). The superiority of RT3DTEE was significant for scallops A2, P1, P2 in MVP and A2, P2 in chordal rupture (all P<0.05). In 22 patients, leaflet clefts were also surgically repaired, and RT3DTEE was feasible in accessing them (κ=0.65, confidence interval [0.44, 0.81]).
Although 2D TEE is currently the standard tool for intraoperative imaging in MV surgery, RT3DTEE improves the visualization of MV pathology and increases the accuracy of interpretation by facilitating spatial orientation. Further investigations, particularly those aimed at establishing its cost effectiveness, are indicated.
成功修复反流性二尖瓣（MV）依赖于对其复杂解剖结构的全面评估。尽管术中实时三维经食管超声心动图（RT3DTEE）在 MV 手术中的可行性和准确性的证据有限，但它在全球范围内的使用正在增加。我们设计了这项前瞻性观察性研究，以测试 RT3DTEE 图像在诊断 MV 脱垂和腱索断裂方面相对于 2D 成像的准确性，并评估 RT3DTEE 用于可视化瓣叶裂的潜力。
TEE 认证的麻醉师通过获取完整的标准 2D TEE 节段和 3D 缩放记录来检查 62 例连续接受 MV 手术的患者。离线时，2D 和 3D 图像独立呈现，并以随机顺序呈现给 2 位专家解释器。准确性使用手术结果作为“金标准”来确定。
手术检查确定了 52 例 MV 脱垂（MVP）病例。RT3DTEE 在检测和定位 MVP（比例差异=33.9%，P<0.001）和腱索断裂（比例差异=25.8%，P<0.001）方面与 2D TEE 相关性更强。RT3DTEE 在 MVP 的 A2、P1、P2 和腱索断裂的 A2、P2 中具有显著优势（均 P<0.05）。在 22 例患者中，瓣叶裂也进行了手术修复，RT3DTEE 可以进入这些瓣叶裂（κ=0.65，置信区间[0.44，0.81]）。
尽管 2D TEE 目前是 MV 手术中术中成像的标准工具，但 RT3DTEE 通过促进空间定位，改善 MV 病理学的可视化，并提高解释的准确性。需要进一步的研究，特别是那些旨在确定其成本效益的研究。
