Gobbi M, Ferlito M, Rapezzi C, Bacchi Reggiani M L, Ortolani P, Piovaccari G, Zimarino M, Magnani G, Marzocchi A, Branzi A
Istituto di Malattie dell'Apparato Cardiovascolare, Università degli Studi, Bologna.
Cardiologia. 1994 Apr;39(4):261-8.
The analysis of valvular morphology is important in selecting patients with mitral rheumatic stenosis for percutaneous mitral valvuloplasty. Transthoracic echocardiography definitely plays a major role in this characterization whereas the usefulness of transesophageal echocardiography has not been determined yet. We studied 95 patients (82 females, 13 males, mean age 51 +/- 12 years) undergoing mitral valvuloplasty (Inoue's technique). The two methods were compared for: morphologic mitral score; correlation between score and increase in mitral valve area; ability to predict post valvuloplasty mitral regurgitation; accuracy in detecting atrial thrombosis. A significant linear correlation between transthoracic and transesophageal echocardiographic scores was observed (r = 0.78, p < 0.001). Transesophageal echocardiographic score was significantly lower (6.8 +/- 1.62 versus 7.17 +/- 1.69, p < 0.05) due to a lower estimation of the extent of calcifications (0.7 +/- 0.97 versus 1 +/- 1.12, p < 0.05). Correlation coefficients between increase in mitral valve area and scores obtained with the two methods were similar (0.29 and 0.30). For both echocardiographic techniques 6 was the best cut-off score value. None of the clinical, hemodynamic and echocardiographic variables was able to predict the occurrence of severe mitral regurgitation. Five patients with atrial thrombosis were identified by transesophageal echocardiography but only 1 by transthoracic echocardiography. We conclude that the two echocardiographic methods have complementary roles in the evaluation of patients undergoing mitral balloon valvuloplasty. Mitral valve morphologic score can generally be assessed adequately by transthoracic echocardiography but transesophageal echocardiography is mandatory in order to exclude left atrial thrombi. The occurrence of post valvuloplasty severe mitral regurgitation cannot be reasonably predicted on echocardiographic basis.
在选择接受经皮二尖瓣成形术的风湿性二尖瓣狭窄患者时，瓣膜形态分析很重要。经胸超声心动图在这一特征描述中肯定起着主要作用，而经食管超声心动图的效用尚未确定。我们研究了95例接受二尖瓣成形术（Inoue技术）的患者（82例女性，13例男性，平均年龄51±12岁）。对两种方法进行了比较：二尖瓣形态评分；评分与二尖瓣面积增加之间的相关性；预测瓣膜成形术后二尖瓣反流的能力；检测心房血栓的准确性。经胸和经食管超声心动图评分之间观察到显著的线性相关性（r = 0.78，p < 0.001）。经食管超声心动图评分显著更低（6.8±1.62对7.17±1.69，p < 0.05），原因是对钙化程度的估计更低（0.7±0.97对1±1.12，p < 0.05）。二尖瓣面积增加与两种方法获得的评分之间的相关系数相似（0.29和0.30）。对于两种超声心动图技术，6是最佳的截断评分值。没有临床、血流动力学和超声心动图变量能够预测严重二尖瓣反流的发生。经食管超声心动图识别出5例心房血栓患者，而经胸超声心动图仅识别出1例。我们得出结论，两种超声心动图方法在评估接受二尖瓣球囊成形术的患者中具有互补作用。二尖瓣形态评分一般可通过经胸超声心动图充分评估，但为了排除左心房血栓，经食管超声心动图是必需的。基于超声心动图无法合理预测瓣膜成形术后严重二尖瓣反流的发生。
