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经食管超声心动图与经胸超声心动图对疑似人工瓣膜心内膜炎的诊断价值比较

Diagnostic value of transesophageal compared with transthoracic echocardiography in suspected prosthetic valve endocarditis.

作者信息

Morguet A J, Werner G S, Andreas S, Kreuzer H

机构信息

Department of Cardiology and Pulmonology, Georg August University, Göttingen, Germany.

出版信息

Herz. 1995 Dec;20(6):390-8.

PMID:8582698
Abstract

To compare transthoracic (TTE) and transesophageal (TEE) echocardiography specifically in prosthetic valve endocarditis, 73 consecutive patients (age, 7 to 80 years) with 86 prostheses who had TTE and TEE for suspected endocarditis were analyzed retrospectively. Thirty-four patients proved to have endocarditis according to clinical criteria (pathoanatomical confirmation in 16), the remaining 39 served as controls. In the endocarditis group, a total of 38 (25 mitral, 13 aortic) prostheses were investigated. Vegetations were detected by TTE in 5 (all aortic) and TEE in 28 (20 mitral, 8 aortic) prostheses (13 vs 74%, p < 0.0001). An annular abscess was found on TEE in 1 mitral implant (3%). New perivalvular regurgitation was demonstrated on TTE in 7 (2 mitral, 5 aortic) and on TEE in 16 (10 mitral, 6 aortic) prostheses (18 vs 42%, p = 0.025). All in all, abnormalities suggestive of endocarditis were revealed on TTE in 10 (2 mitral, 8 aortic) and on TEE in 35 (23 mitral, 12 aortic) prostheses (sensitivity 26 and 92%, p < 0.0001). In the control group, TEE was false positive in 1 mitral prosthesis (specificity for TTE and TEE 100 and 97%, respectively; p = NS). These results indicate that TEE is markedly superior to TTE in prosthetic valve endocarditis. The diagnostic advantage is most evident in mitral prostheses. This holds for the detection of both morphologic changes and prosthetic malfunction.

摘要

为了特别比较经胸超声心动图(TTE)和经食管超声心动图(TEE)在人工瓣膜心内膜炎中的应用,我们对73例连续患者(年龄7至80岁)进行了回顾性分析,这些患者共有86个人工瓣膜,因疑似心内膜炎接受了TTE和TEE检查。根据临床标准,34例患者被证实患有心内膜炎(16例经病理解剖确诊),其余39例作为对照。在心内膜炎组中,共研究了38个人工瓣膜(25个二尖瓣,13个主动脉瓣)。TTE检测到5个(均为主动脉瓣)人工瓣膜有赘生物,TEE检测到28个(20个二尖瓣,8个主动脉瓣)人工瓣膜有赘生物(13%对74%,p<0.0001)。TEE发现1个二尖瓣植入物有瓣周脓肿(3%)。TTE显示7个(2个二尖瓣,5个主动脉瓣)人工瓣膜有新的瓣周反流,TEE显示16个(10个二尖瓣,6个主动脉瓣)人工瓣膜有新的瓣周反流(18%对42%,p = 0.025)。总体而言,TTE显示10个(2个二尖瓣,8个主动脉瓣)人工瓣膜有提示心内膜炎的异常,TEE显示35个(23个二尖瓣,12个主动脉瓣)人工瓣膜有提示心内膜炎的异常(敏感性分别为26%和92%,p<0.0001)。在对照组中,TEE在1个二尖瓣人工瓣膜中出现假阳性(TTE和TEE的特异性分别为100%和97%;p无统计学意义)。这些结果表明,在人工瓣膜心内膜炎中,TEE明显优于TTE。诊断优势在二尖瓣人工瓣膜中最为明显。这在形态学改变和人工瓣膜功能障碍的检测方面均成立。

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