Caso P, Ascione L, Lange A, Palka P, Mininni N, Sutherland G R
Divisione di Cardiologia, Ospedale Monaldi, Napoli, Italy.
Am Heart J. 1998 Jan;135(1):43-50. doi: 10.1016/s0002-8703(98)70341-2.
This study was designed to evaluate the relative diagnostic values of transthoracic (TTE) and transesophageal (TEE) echocardiography in the assessment of congenitally corrected transposition of the great arteries in adult patients. Twelve patients (mean age 29 years, range 21 to 39 years) with congenitally corrected transposition of the great arteries underwent both TTE and TEE examinations to assess this complex cardiac lesion. Of the 12 patients evaluated, situs solitus and inversus were present in 8 and in 4 patients, respectively. TTE correctly identified atrial situs in only 10 patients, whereas TEE, directly evaluating the morphologic features of either appendage, correctly determined situs in every patient. In all 11 patients with intact inlet ventricular septum, the spatial relationship between the septal leaflets of atrioventricular valves was correctly evaluated by both techniques. However, the chordal attachments of both valves were clearly elucidated by TEE in all patients, whereas TTE could obtain images of these in only three patients. TTE was able to evaluate the discordant connection between the right ventricle and the anterior vessel (aorta) in 10 patients, whereas the connection between the left ventricle and the posterior vessel was clearly shown only in 7 patients. Transesophageal longitudinal planes better elucidated these two discordances in all patients irrespective of the position of the heart in the chest and atrial situs. Four patients had an associated ventricular septal defect (inlet defect in one, perimembranous in two, and muscular in one); the inlet defect was unrestrictive and could be easily detected by either imaging technique, whereas the membranous was detected by TTE and by the horizontal transesophageal planes; the muscular defect was recognized only by TTE. Three patients had an associated pulmonary stenosis; Doppler transthoracic echocardiography showed a left outflow peak gradient of 100 mm Hg in two patients and of 80 mm Hg in one but failed to adequately assess the morphologic features of the stenosis, whose features were clearly visualized by transesophageal longitudinal planes in all patients. In conclusion, in our experience TEE is superior to transthoracic imaging in studying congenitally corrected transposition of the great arteries in adult patients; the horizontal plane is best suited to the evaluation of atrial situs and the atrioventricular junction, whereas the longitudinal plane is most valuable in the study of the morphologic features of the ventriculoarterial connections. These findings should be equally applicable to multiplane transesophageal studies.
本研究旨在评估经胸超声心动图（TTE）和经食管超声心动图（TEE）在评估成年患者先天性矫正型大动脉转位时的相对诊断价值。12例先天性矫正型大动脉转位患者（平均年龄29岁，范围21至39岁）接受了TTE和TEE检查，以评估这一复杂的心脏病变。在评估的12例患者中，心房正位和反位分别有8例和4例。TTE仅在10例患者中正确识别了心房位置，而TEE通过直接评估任一附属结构的形态特征，在每例患者中都正确确定了位置。在所有11例入口室间隔完整的患者中，两种技术均正确评估了房室瓣间隔叶之间的空间关系。然而，TEE在所有患者中都清晰地显示了两个瓣膜的腱索附着情况，而TTE仅在3例患者中获得了这些图像。TTE能够在10例患者中评估右心室与前方血管（主动脉）之间的不一致连接，而左心室与后方血管之间的连接仅在7例患者中清晰显示。经食管纵向平面能更好地阐明所有患者的这两种不一致情况，无论心脏在胸腔中的位置和心房位置如何。4例患者伴有室间隔缺损（1例为入口缺损，2例为膜周部缺损，1例为肌部缺损）；入口缺损无限制，两种成像技术均可轻松检测到，而膜周部缺损由TTE和经食管水平平面检测到；肌部缺损仅由TTE识别。3例患者伴有肺动脉狭窄；经胸多普勒超声心动图显示2例患者左心室流出道峰值压差为100 mmHg，1例为80 mmHg，但未能充分评估狭窄的形态特征，而所有患者经食管纵向平面均清晰显示了狭窄的特征。总之，根据我们的经验，在研究成年患者先天性矫正型大动脉转位时，TEE优于经胸成像；水平面最适合评估心房位置和房室连接，而纵向平面在研究心室动脉连接的形态特征方面最有价值。这些发现同样适用于多平面经食管研究。
