Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2013 Jul;76(7):372-7. doi: 10.1016/j.jcma.2013.04.001. Epub 2013 May 9.
Two-dimensional transesophageal echocardiography (2D TEE) Doppler color flow imaging is the gold standard for assessing the severity of mitral regurgitation (MR). Severe MR with very eccentric jet may involve more than one mitral leaflet lesion and can be missed by 2D TEE. The purpose of this study was to assess the usefulness and the incremental value of real-time three-dimensional (RT 3D) TEE over 2D TEE findings in the evaluation of patients suffering eccentric MR with more than one mitral leaflet lesion.
Intraoperative 2D TEE and RT 3D TEE examinations were performed on 168 patients with Carpenter II MR who underwent surgery. MR was defined as either central, free-standing eccentric jet or very eccentric jet. 2D TEE and RT 3D TEE finding were compared with surgical findings.
Of these 168 MR patients, 25 patients (14.9%) had central jets and 143 patients (85.1%) had eccentric jets. Among 143 patients with eccentric jets, 47 patients (32.9%) had free-standing eccentric MR jets, and 96 (67.1%) patients had very eccentric jets. 3D TEE diagnosed the severity and location of MR lesions correctly in all patients; this was not the case with 2D TEE, which had significant diagnostic misses in nine patients (9.4%, p < 0.001) having MR with very eccentric jets. These nine patients had lesions on both mitral leaflets, which were missed during 2D TEE examination owing to the highly turbulent flows produced by very eccentric jets from one mitral leaflet lesion and impinging the opposite mitral leaflet lesion.
The severity of MR with very eccentric jet was more accurately and comprehensively assessed by 3D TEE than by 2D TEE. Therefore, intraoperative RT 3D TEE provides incremental information that is generally superior to 2D TEE in patients with complex MR due to very eccentric jets.
二维经食管超声心动图（2D TEE）多普勒彩色血流成像一直是评估二尖瓣反流（MR）严重程度的金标准。严重的偏心射流 MR 可能涉及多个二尖瓣瓣叶病变，二维 TEE 可能会漏诊。本研究旨在评估实时三维（RT 3D）TEE 在评估多个二尖瓣瓣叶病变的偏心性 MR 患者中的作用和附加价值。
对 168 例接受手术的 Carpenter II 型 MR 患者进行术中二维 TEE 和 RT 3D TEE 检查。MR 定义为中央射流、独立的偏心射流或非常偏心射流。比较二维 TEE 和 RT 3D TEE 与手术结果。
在这 168 例 MR 患者中，25 例（14.9%）有中央射流，143 例（85.1%）有偏心射流。在 143 例偏心射流患者中，47 例（32.9%）有独立的偏心 MR 射流，96 例（67.1%）有非常偏心射流。RT 3D TEE 正确诊断了所有患者的 MR 病变严重程度和位置；二维 TEE 则不然，9 例（9.4%，p<0.001）非常偏心射流 MR 患者存在明显的漏诊。这 9 例患者的二尖瓣瓣叶均有病变，由于来自一个二尖瓣瓣叶病变的非常偏心射流产生的高度湍流和冲击对侧二尖瓣瓣叶病变，二维 TEE 检查漏诊。
与二维 TEE 相比，3D TEE 更准确、全面地评估了非常偏心射流的 MR 严重程度。因此，在由于非常偏心射流导致的复杂 MR 患者中，术中 RT 3D TEE 提供的信息通常优于二维 TEE，具有附加价值。
