Anwar Ashraf M, Nosir Youssef F M, Alasnag Mirvat, Chamsi-Pasha Hassan
Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Echocardiography. 2014 Feb;31(2):188-96. doi: 10.1111/echo.12327. Epub 2013 Aug 13.
To explore our initial experience with real time three-dimensional transesophageal echocardiography (RT3DTEE) for the assessment of prosthetic valves (PV).
The study included 40 patients (mean age 35 ± 8.5 years, 68% male) who underwent PV implant. Fifty PV (34 bioprosthetic and 16 mechanical) were evaluated using two-dimensional (2D)TEE and RT3DTEE to rule out PV dysfunction.
In all patients, RT3DTEE allowed good and simultaneous visualization of PV leaflets. Ten patients had normal functioning PV (5 in mitral, 3 in aortic, and 2 in tricuspid positions). Infective endocarditis was evident in 13 patients (20 PV) by repeated 2DTEE. RT3DTEE confirmed the 2DTEE diagnosis of endocarditis in same patients. Clear delineation of vegetations (size, site, and number) was obtained from RT3DTEE full volume while the vegetation attachment, consistency, mobility and its relation to valve structure were obtained using zoom 3D. Paraaortic abscesses size, site, extension, wall thickness of the abscess could be identified by RT3DTEE in 7 PV. Through cropping of the full-volume 3D images, the orifice of communication between the abscess cavity and aorta could be visualized well in en face view. Color full-volume allowed the detection of paravalvular regurgitation (size, location, direction, and extent) in 8 patients. In the 18 PV who underwent redo surgery, the intra-operative findings confirmed the RT3DTEE description of PV lesions.
Real time 3DTEE improved the anatomical and functional assessment of PV with better understanding of the underlying causes of PV dysfunction; hence, it could improve the management planning for such patients.
探讨我们使用实时三维经食管超声心动图（RT3DTEE）评估人工瓣膜（PV）的初步经验。
该研究纳入了40例行PV植入术的患者（平均年龄35±8.5岁，68%为男性）。使用二维（2D）TEE和RT3DTEE对50个人工瓣膜（34个生物瓣膜和16个机械瓣膜）进行评估，以排除PV功能障碍。
在所有患者中，RT3DTEE能够很好地同时显示PV瓣叶。10例患者的PV功能正常（二尖瓣位置5例，主动脉瓣位置3例，三尖瓣位置2例）。通过反复2DTEE检查，13例患者（20个PV）存在感染性心内膜炎。RT3DTEE在相同患者中证实了2DTEE对心内膜炎的诊断。RT3DTEE全容积图像清晰显示了赘生物的大小、部位和数量，而使用三维局部放大功能可观察到赘生物的附着情况、质地、活动度及其与瓣膜结构的关系。RT3DTEE可在7个PV中识别主动脉旁脓肿的大小、部位、范围和脓肿壁厚度。通过裁剪全容积三维图像，可在正面视图中很好地观察到脓肿腔与主动脉之间的交通口。彩色全容积成像可检测到8例患者的瓣周反流（大小、位置、方向和程度）。在18个接受再次手术的PV中，术中发现证实了RT3DTEE对PV病变的描述。
实时三维TEE改善了对PV的解剖和功能评估，能更好地了解PV功能障碍的潜在原因；因此，它可以改善此类患者的管理规划。
