Niedermeyer J, Daniel W G
Zentrum Innere Medizin und Dermatologie der Medizinischen Hochschule Hannover.
Herz. 1993 Dec;18(6):329-40.
In the clinical management of patients with valvular heart disease, transthoracic echocardiography (TTE) combined with Doppler has become the central diagnostic tool during the past decades. The development of transesophageal echocardiography (TEE) has led to an improved image quality especially of structures distant to the chest wall. However, since TEE is a semi-invasive technique, its use has to be considered carefully. In aortic valve disease, TEE facilitates a detailed study of valve morphology and allows sufficiently reliable planimetry of aortic valve area, at least when the multiplane approach is used. This is particularly helpful in those patients where Doppler interrogation from precordial windows fails. Aortic regurgitation is diagnosed more frequently by TEE color-flow imaging than by TTE; however, both techniques allow only semiquantitative assessment of the severity of regurgitation. TEE is also superior to TTE in defining the exact origin site, number and configuration of regurgitant jets in patients with mitral insufficiency. In particular minimal and mild mitral regurgitation is more easily detected by TEE than by TTE. The same is true for flail mitral leaflets, chordal and papillary muscle rupture, and potentially also for discrete forms of mitral valve prolapse. During surgery, TEE can be considered as an ideal tool for immediate assessment of the results of mitral valve reconstruction. Calculation of pressure gradients and valve area by TEE Doppler analysis shows comparable results to precordial studies. When multiplane TEE is available, Doppler beam alignment may become even improved in selected cases with severely excentric flow jet orientation. In addition, TEE provides of course clinically important information concerning presence or absence of atrial and particularly atrial appendage thrombi as well as of spontaneous echo contrast in patients with stenotic mitral valve. This is not only helpful regarding the decision for anticoagulation but it may also be critical in the selection of candidates for percutaneous mitral balloon valvuloplasty. TEE does also allow the morphological and functional evaluation of tricuspid and pulmonic valves. In this context, the use of biplane or multiplane TEE probes is superior to that of monoplane devices. However, currently available data does not provide unequivocal evidence that the analysis of tricuspid and pulmonic valve disease by TEE is superior to the conventional transthoracic approach.
在心脏瓣膜病患者的临床管理中，经胸超声心动图（TTE）结合多普勒技术在过去几十年已成为核心诊断工具。经食管超声心动图（TEE）的发展使图像质量得到改善，尤其是对远离胸壁的结构成像。然而，由于TEE是一种半侵入性技术，其使用必须谨慎考虑。在主动脉瓣疾病中，TEE有助于详细研究瓣膜形态，并能对主动脉瓣面积进行足够可靠的平面测量，至少在使用多平面方法时如此。这对那些经胸壁窗口进行多普勒检查失败的患者尤其有帮助。通过TEE彩色血流成像诊断主动脉瓣反流比TTE更频繁；然而，两种技术都只能对反流严重程度进行半定量评估。在确定二尖瓣关闭不全患者反流束的确切起源部位、数量和形态方面，TEE也优于TTE。特别是轻微和轻度二尖瓣反流，TEE比TTE更容易检测到。连枷样二尖瓣叶、腱索和乳头肌破裂以及二尖瓣脱垂的离散形式也是如此。在手术过程中，TEE可被视为立即评估二尖瓣重建结果的理想工具。通过TEE多普勒分析计算压力阶差和瓣膜面积，其结果与经胸壁研究相当。当有多平面TEE可用时，在某些具有严重偏心血流束方向的病例中，多普勒束的对齐可能会得到进一步改善。此外，TEE当然还能提供有关二尖瓣狭窄患者心房尤其是心耳血栓的存在与否以及自发回声增强的重要临床信息。这不仅有助于做出抗凝决策，在选择经皮二尖瓣球囊成形术的候选患者时也可能至关重要。TEE还能对三尖瓣和肺动脉瓣进行形态和功能评估。在这种情况下，使用双平面或多平面TEE探头优于单平面设备。然而，目前可得的数据并未提供明确证据表明TEE对三尖瓣和肺动脉瓣疾病的分析优于传统的经胸方法。
