Pham Thao Thi Thanh, Kirkpatrick James N, Duong Hung Duc, Pham Hung Manh, Vu Thom Thi, Giap Nguyet Thi Minh, Trinh Ha Viet, Nguyen Yen Thi Hai, Hoang Mai Thi Ngoc, Nguyen Hoai Thi Thu
Vietnam National Heart Institute, Bach Mai Hospital.
University of Washington Medical Center, Seattle, Washington, USA.
Ann Med Surg (Lond). 2023 Apr 11;85(5):1358-1365. doi: 10.1097/MS9.0000000000000601. eCollection 2023 May.
The aim of this study was to determine the accuracy of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the detection of pannus and thrombus in left mechanical valve obstruction (LMVO) compared with surgical and histopathology findings.
Patients with suspected LMVO on transthoracic echocardiography were enrolled consecutively. All patients underwent two-dimensional and three-dimensional TEE, and open-heart surgery to replace obstructed valves. Macroscopic and microscopic analysis of the excised masses was used as the gold standard for the diagnosis of thrombus and/or pannus.
Forty-eight patients [34 women (70.8%), age 49±13 years, New York Heart Association II: 68.8%, New York Heart Association III: 31.2%] were enrolled. In the diagnostic of thrombus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 89.2, 72.7, 85.4, 91.7, and 66.7%, respectively, compared with those of two-dimensional TEE (42.2, 66.7, 43.8, 95, and 7.1%, respectively). In the diagnosis of pannus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 53.3, 100, 85.4, 100, and 82.5%, respectively; compared with those of two-dimensional TEE (7.4, 90.5, 43.8, 50, and 43.2%, respectively). Receiver operating characteristic curves depict that the area under the curves of three-dimensional TEE was higher than the area under the curves of two-dimensional TEE in both diagnoses of thrombus and pannus (0.8560 vs. 0.7330, =0.0427 and 0.8077 vs. 0.5484, =0.005, respectively).
This study indicated that three-dimensional TEE had a higher diagnostic value than two-dimensional TEE in the detection of thrombus and pannus in patients with LMVO, and can be a reliable imaging modality to identify the causes of LMVO.
本研究的目的是确定与手术及组织病理学结果相比，二维和三维经食管超声心动图（TEE）在检测左心机械瓣膜梗阻（LMVO）中的赘生物和血栓方面的准确性。
连续纳入经胸超声心动图怀疑有LMVO的患者。所有患者均接受二维和三维TEE检查以及心脏直视手术以置换梗阻瓣膜。对切除肿块进行宏观和微观分析，以此作为诊断血栓和/或赘生物的金标准。
共纳入48例患者[34名女性（70.8%），年龄49±13岁，纽约心脏协会II级：68.8%，纽约心脏协会III级：31.2%]。在血栓诊断方面，三维TEE的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为89.2%、72.7%、85.4%、91.7%和66.7%，而二维TEE的相应值分别为42.2%、66.7%、43.8%、95%和7.1%。在赘生物诊断方面，三维TEE的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为53.3%、100%、85.4%、100%和82.5%；二维TEE的相应值分别为7.4%、90.5%、43.8%、50%和43.2%。受试者工作特征曲线显示，在血栓和赘生物的诊断中，三维TEE曲线下面积均高于二维TEE曲线下面积（分别为0.8560对0.7330，P = 0.0427；0.8077对0.5484，P = 0.005）。
本研究表明，三维TEE在检测LMVO患者的血栓和赘生物方面比二维TEE具有更高的诊断价值，并且可作为一种可靠的成像方式来确定LMVO的病因。
