Rittoo D, Sutherland G R, Currie P, Starkey I R, Shaw T R
Department of Cardiology, Western General Hospital, Edinburgh, United Kingdom.
Am Heart J. 1993 Apr;125(4):1094-105. doi: 10.1016/0002-8703(93)90119-t.
Transthoracic (TTE) and transesophageal echocardiography (TEE) were performed prospectively on 53 consecutive patients (mean age 59 +/- 14 years) immediately before and within 24 hours of mitral balloon valvotomy to compare the relative value of the two techniques. Biplane TEE was used in 38 patients and single-plane imaging was done in 11. All patients underwent left and right cardiac catheterization, left ventriculography, and coronary angiography. While TEE provided excellent images of the mitral valve in all patients, imaging planes were more limited than by TTE. Mitral valve morphology could be assessed satisfactorily by either technique. Echo scores derived from each showed good correlation (r = 0.90, p < 0.001). TEE transgastric longitudinal scanning provided superior detail of the subvalvar apparatus but only in 20 (53%) of 38 patients. Patients with good transgastric views had significantly smaller left atrial volumes than those without (58 +/- 22 vs 106 +/- 41 cm3, p < 0.001). Mitral valve orifice and the commissures were better assessed by TTE. Before valvotomy, mitral regurgitation (MR) graded by TEE and TTE color flow mapping was concordant with angiography in 80% and 81%, respectively. After valvotomy, TTE color flow mapping failed to detect MR in two of the three patients who developed severe MR. Two of these patients were examined by TEE, which demonstrated both the MR jets as well as leaflet tears. Thrombus was diagnosed in the left atrium in eight patients by TEE and in only one patient by TTE. Biplane TEE was required for accurate thrombus localization and for assessing its size and extent. Five patients with thrombus underwent balloon valvotomy without complications. Left-to-right atrial shunting was detected by TEE and TTE in 95% and 48% of patients, respectively. Flow convergence regions, from which quantitative flow information can be derived, were imaged by TEE only. TTE and TEE have complementary roles. However, TEE is essential for excluding thrombus in the left atrium before balloon valvotomy. After the procedure, TEE is recommended for the evaluation of patients with severe mitral regurgitation.
对53例连续患者（平均年龄59±14岁）在二尖瓣球囊瓣膜成形术前即刻及术后24小时内进行了经胸超声心动图（TTE）和经食管超声心动图（TEE）检查，以比较这两种技术的相对价值。38例患者使用双平面TEE，11例进行单平面成像。所有患者均接受了左、右心导管检查、左心室造影和冠状动脉造影。虽然TEE在所有患者中都能提供二尖瓣的优良图像，但成像平面比TTE更有限。两种技术均可满意地评估二尖瓣形态。每种方法得出的回声评分显示出良好的相关性（r = 0.90，p < 0.001）。TEE经胃纵向扫描仅在38例患者中的20例（53%）中提供了瓣下结构的更详细图像。有良好经胃视野的患者左心房容积明显小于无此视野的患者（58±22 vs 106±41 cm³，p < 0.001）。二尖瓣口和瓣叶交界通过TTE评估更佳。在瓣膜成形术前，TEE和TTE彩色血流图分级的二尖瓣反流（MR）与血管造影的一致性分别为80%和81%。瓣膜成形术后，在发生严重MR的3例患者中，有2例TTE彩色血流图未能检测到MR。其中2例患者接受了TEE检查，TEE显示了MR喷射以及瓣叶撕裂。TEE诊断出8例患者左心房有血栓，而TTE仅诊断出1例。准确的血栓定位以及评估其大小和范围需要双平面TEE。5例有血栓的患者接受了球囊瓣膜成形术，无并发症。分别有95%和48%的患者通过TEE和TTE检测到左向右心房分流。仅通过TEE对可从中获取定量血流信息的血流会聚区进行了成像。TTE和TEE具有互补作用。然而，TEE对于在球囊瓣膜成形术前排除左心房血栓至关重要。术后，建议对有严重二尖瓣反流的患者进行TEE评估。
