Pieper E P, Hellemans I M, Hamer H P, Ravelli A C, Jaarsma W, Breekland A, Lie K I, Visser C A
Department of Cardiology, University Hospital Groningen, The Netherlands.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):748-55. doi: 10.1016/S1053-0770(96)80200-X.
To determine the value of biplane transesophageal echocardiography in the assessment of severity of mitral regurgitation compared with left ventricular angiography.
Prospective study of consecutive patients.
Two university hospitals, one community hospital.
Thirty-seven patients with angiographically proven mitral regurgitation.
Transthoracic and biplane transesophageal echocardiography. In 19 patients, transesophageal echocardiography was performed during general anesthesia.
The largest mitral regurgitation jet area and longest jet as obtained with Doppler color-flow mapping from transthoracic and biplane transesophageal echocardiography and pulsed-Doppler pulmonary venous flow characteristics. Sensitivity and 100-minus-specificity were plotted to constitute receiver operating characteristics (ROC) curves. Areas under ROC curve for transverse, longitudinal, and biplane jet area were 0.77, 0.75, and 0.81, and for jet length, 0.82, 0.84, and 0.88, respectively; this was for biplane jet area in conscious patients; 0.99 compared with 0.72 in anesthetized patients (p < 0.05).
Biplane measurements identified severe mitral regurgitation slightly more reliably than the transverse or longitudinal measurements alone. In conscious patients, jet area was an excellent test for estimating severity of mitral regurgitation. In anesthetized patients, a combination of biplane jet area and length and of systolic pulmonary venous flow reversal accurately predicted angiographic severity of mitral regurgitation. In anesthetized patients, the optimal cut-off value for jet area to distinguish between moderate and severe mitral regurgitation was lower than in conscious patients. In the total population, regardless of hemodynamic and technical variations, a combination of biplane jet area and length and of systolic pulmonary venous flow reversal accurately predicted the severity of mitral regurgitation.
与左心室血管造影术相比，确定双平面经食管超声心动图在评估二尖瓣反流严重程度方面的价值。
对连续患者进行的前瞻性研究。
两家大学医院，一家社区医院。
37例经血管造影证实有二尖瓣反流的患者。
经胸和双平面经食管超声心动图检查。19例患者在全身麻醉下进行经食管超声心动图检查。
通过经胸和双平面经食管超声心动图的多普勒彩色血流图获得最大二尖瓣反流束面积和最长反流束，以及脉冲多普勒肺静脉血流特征。绘制敏感性和100减去特异性以构成受试者操作特征（ROC）曲线。横向、纵向和双平面反流束面积的ROC曲线下面积分别为0.77、0.75和0.81，反流束长度的ROC曲线下面积分别为0.82、0.84和0.88；这是针对清醒患者的双平面反流束面积；麻醉患者中为0.99，而清醒患者中为0.72（p< 0.05）。
双平面测量比单独的横向或纵向测量更可靠地识别严重二尖瓣反流。在清醒患者中，反流束面积是评估二尖瓣反流严重程度的极佳指标。在麻醉患者中，双平面反流束面积和长度以及收缩期肺静脉血流逆转的组合可准确预测二尖瓣反流的血管造影严重程度。在麻醉患者中，区分中度和重度二尖瓣反流的反流束面积最佳截断值低于清醒患者。在总体人群中，无论血流动力学和技术差异如何，双平面反流束面积和长度以及收缩期肺静脉血流逆转的组合可准确预测二尖瓣反流的严重程度。
