Castillo J A, Vilacosta I, Almería C, San Román J A, Zamorano J L, Rollán M J, Domínguez-Arganda L, Peral V, Sánchez-Harguindey L
Servicio de Cardiología, Hospital Universitario de San Carlos, Madrid.
Rev Esp Cardiol. 1994 Jul;47(7):454-60.
The aim of this study was to assess the usefulness of transesophageal echocardiography for detection of the mechanism of dysfunction in bioprosthetic valves in the mitral position.
Transthoracic and transesophageal echocardiograms were performed in 40 patients (mean age 61 +/- 12 years) with a dysfunctional bioprosthetic mitral valve. Echocardiographic results were compared to surgical findings in all except 1 patient.
All 9 patients with stenotic degenerated bioprosthesis were diagnosed by transthoracic and transesophageal echocardiography. Mechanism of dysfunction in the remaining patients were as follows: cusp tear or rupture in 18, dehiscence in 4 and endocarditis in 6. Transthoracic and transesophageal echocardiography visualized respectively: 8 (44%) and 15 (83%; p < 0.05) with cusp tears or ruptures; 3 (75%) and 3 (75%) with dehiscence; 3 (50%) and 6 (100%; p < 0.1) with endocarditis. One patient with pannus formation and 1 of 2 bioprosthetic thrombosis were not correctly identified by either echocardiographic technique.
Transesophageal echocardiography is suited for the assessment of mechanism of mitral regurgitation and for the diagnosis of vegetations in most of patients with bioprosthetic mitral valves. Transesophageal echocardiography adds little information to the transthoracic study in the evaluation of patients with stenotic bioprosthetic mitral valves, particularly in calcified degeneration.
本研究旨在评估经食管超声心动图在检测二尖瓣位生物瓣功能障碍机制方面的实用性。
对40例（平均年龄61±12岁）二尖瓣位生物瓣功能障碍患者进行经胸和经食管超声心动图检查。除1例患者外，将超声心动图结果与手术发现进行比较。
所有9例狭窄性退化生物瓣患者均经经胸和经食管超声心动图诊断。其余患者的功能障碍机制如下：瓣叶撕裂或破裂18例，瓣周漏4例，心内膜炎6例。经胸和经食管超声心动图分别显示：瓣叶撕裂或破裂的患者为8例（44%）和15例（83%；p<0.05）；瓣周漏的患者为3例（75%）和3例（75%）；心内膜炎的患者为3例（50%）和6例（100%；p<0.1）。1例有血管翳形成的患者和2例生物瓣血栓形成患者中的1例，两种超声心动图技术均未正确识别。
经食管超声心动图适用于评估大多数二尖瓣位生物瓣患者的二尖瓣反流机制及赘生物诊断。在评估狭窄性二尖瓣位生物瓣患者，特别是钙化性退变患者时，经食管超声心动图相对于经胸检查增加的信息很少。
