Leung D Y, Cranney G B, Hopkins A P, Walsh W F
Department of Cardiovascular Medicine, Prince Henry Hospital, Sydney, New South Wales, Australia.
Br Heart J. 1994 Aug;72(2):175-81. doi: 10.1136/hrt.72.2.175.
To assess and compare the roles of transthoracic and transoesophageal echocardiography in the diagnosis and management of an aortic root abscess.
To select patients with echocardiographic diagnosis of aortic valve endocarditis with and without an aortic root abscess and correlate this with a retrospective review of surgical and necropsy data.
Tertiary referral centre at a university teaching hospital.
34 patients with confirmed aortic valve endocarditis were treated over a four and a half year period. All patients underwent both transthoracic and transoesophageal echocardiography with 17 patients having biplane or multiplane imaging.
11 patients (32%) had an aortic root abscess. Transthoracic echocardiography identified four cases of aortic root abscess whereas transoesophageal echocardiography correctly detected all 11 cases and also detected complications including mitral aortic intervalvar fibrosa fistula in two patients and right atrial involvement in another two patients. Only biplane imaging was able to show an anterior aortic root abscess in one patient and the circumferential involvement of the aortic annulus in another two patients. All patients with an aortic root abscess were treated surgically after transoesophageal echocardiographic diagnosis. After operation, prosthetic aortic regurgitation was present in seven patients and a repeat operation was performed in three patients. Only transoesophageal echocardiography detected a postoperative aorto-right atrial fistula in two patients and recurrence of the root abscess in another. There were five deaths in hospital (45%).
Compared with transthoracic echocardiography, transoesophageal echocardiography was more sensitive and more specific for the early diagnosis of aortic root abscess and its complications and facilitated both the preoperative and postoperative management of these patients. Biplane and multiplane imaging provide additional diagnostic information. All patients with suspected aortic valve endocarditis should have an early transoesophageal echocardiographic study.
评估和比较经胸超声心动图与经食管超声心动图在主动脉根部脓肿诊断及治疗中的作用。
选择经超声心动图诊断为主动脉瓣心内膜炎且伴有或不伴有主动脉根部脓肿的患者，并将其与手术及尸检数据的回顾性分析结果相关联。
一所大学教学医院的三级转诊中心。
在四年半的时间里，对34例确诊为主动脉瓣心内膜炎的患者进行了治疗。所有患者均接受了经胸超声心动图和经食管超声心动图检查，其中17例患者进行了双平面或多平面成像。
11例患者（32%）存在主动脉根部脓肿。经胸超声心动图发现4例主动脉根部脓肿，而经食管超声心动图正确检测出所有11例病例，还检测到并发症，包括2例患者出现二尖瓣-主动脉瓣纤维三角瘘，另外2例患者出现右心房受累。只有双平面成像能够显示1例患者的主动脉根部前方脓肿以及另外2例患者主动脉瓣环的周向受累情况。所有主动脉根部脓肿患者在经食管超声心动图诊断后均接受了手术治疗。术后，7例患者出现人工主动脉瓣反流，3例患者接受了再次手术。只有经食管超声心动图检测到2例患者术后出现主动脉-右心房瘘，另1例患者根部脓肿复发。住院期间有5例死亡（45%）。
与经胸超声心动图相比，经食管超声心动图对主动脉根部脓肿及其并发症的早期诊断更敏感、更具特异性，有助于这些患者的术前和术后管理。双平面和多平面成像可提供额外的诊断信息。所有疑似主动脉瓣心内膜炎的患者均应尽早进行经食管超声心动图检查。
