Bobadilla J F, García-Fernández M A, Moreno M, Garrido P, Torrecilla E G, San Román D J, Sousa R C, Bermejo J, Delcán J L
Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid.
Rev Esp Cardiol. 1995 Mar;48(3):176-82.
The purpose of this study was to determine whether multiplanar (MP) transesophageal echocardiographic views were superior to standard views (ST), in the evaluation of mitral prosthesis regurgitation (MR), particularly in presence of wall regurgitant jets.
We studied all mitral prostheses (n = 43) in which pathological mitral regurgitation had been detected by multiplanar TEE between January 1993 and March 1994. Regurgitant prostheses were classified in two groups according to the presence of wall regurgitant jets and maximum turbulent color flow areas (Amax.) were measured on standard (0 and 90 degrees) and MP (0 to 180 degrees) views.
The Amax. detected on ST views were 5.80 +/- 4.60 cm2 and on MP 7.42 +/- 5.13 cm2. Student's test was used to compare both areas and significant differences were found: 1.61 cm2; 95% confidence interval from 0.94 to 2.28 cm2; p = 0.000025. The sample was divided in two groups, A (n = 33): with wall jets and B (n = 10): without wall jets. The Amax. for group A was 5.64 +/- 4.30 cm2 in ST views, and 7.51 +/- 5.12 cm2 in MP. The difference was statistically significant: 1.86 cm2, 95% c.i. from 1.04 to 2.68 cm2; p = 0.00009. Differences for group B were also statistically significant: 0.68 cm2; p = 0.0172. MP views detected a bigger regurgitant area in 26 of the 43 cases (60%). The difference between ST and MP views was significantly bigger for group A than for group B: mean 1.18 cm2; p = 0.0176. MP views detected a severer degree of MR, classified as mild moderate and severe according to the color flow area, than ST views in 8 patients. All of them had wall regurgitant jets. Three had been considered normal on ST views.
We conclude that MP transesophageal views are significantly superior to ST in the assessment of regurgitant prosthetic mitral valves, particularly in presence of wall regurgitant jets. Our data strongly suggest that multiplanar TEE is the procedure of choice in the assessment of wall regurgitant mitral prostheses.
本研究旨在确定多平面（MP）经食管超声心动图视图在评估二尖瓣人工瓣膜反流（MR）方面是否优于标准视图（ST），特别是在存在壁反流束的情况下。
我们研究了1993年1月至1994年3月期间通过多平面经食管超声心动图检测到病理性二尖瓣反流的所有二尖瓣人工瓣膜（n = 43）。根据壁反流束的存在将反流性人工瓣膜分为两组，并在标准（0度和90度）和MP（0至180度）视图上测量最大湍流彩色血流面积（Amax.）。
在ST视图上检测到的Amax.为5.80±4.60平方厘米，在MP视图上为7.42±5.13平方厘米。使用学生检验比较这两个面积，发现有显著差异：1.61平方厘米；95%置信区间为0.94至2.28平方厘米；p = 0.000025。样本分为两组，A组（n = 33）：有壁束，B组（n = 10）：无壁束。A组在ST视图上的Amax.为5.64±4.30平方厘米，在MP视图上为7.51±5.12平方厘米。差异具有统计学意义：1.86平方厘米，95%置信区间为1.04至2.68平方厘米；p = 0.00009。B组的差异也具有统计学意义：0.68平方厘米；p = 0.0172。MP视图在43例病例中的26例（60%）中检测到更大的反流面积。A组ST和MP视图之间的差异比B组显著更大：平均1.18平方厘米；p = 0.0176。根据彩色血流面积分类为轻度、中度和重度的MR，MP视图检测到的程度比ST视图更严重的有8例患者。他们都有壁反流束。其中3例在ST视图上被认为是正常的。
我们得出结论，在评估反流性人工二尖瓣时，MP经食管视图明显优于ST视图，特别是在存在壁反流束的情况下。我们的数据强烈表明，多平面经食管超声心动图是评估有壁反流的二尖瓣人工瓣膜的首选方法。
