摘要
目的:应用经食道超声心动图序列二尖瓣病变定位切面与术中发现进行对照研究,寻找对应二尖瓣不同小叶分区的相应切面及标准化操作规程,以供临床决策及提高手术成功率。方法:二尖瓣脱垂并伴有中度以上的二尖瓣反流拟行外科手术患者53例。术前行食道超声检测瓣膜病变类型与小叶分区定位,与术中发现进行对照。二尖瓣的解剖定位采用Carpentier命名法,将前叶分为A1、A2及A3,后叶分为P1、P2及P3。术前1周及术中食道超声应用中食道四腔心切面、中食道5腔心切面、显示冠状静脉窦的短四腔心切面、两腔心切面、二尖瓣交界区两腔心切面、中食道左心室长轴切面及胃底左心室短轴切面进行二尖瓣病变的小叶分区定位。外科医生术中记录二尖瓣瓣膜脱垂、腱索断裂等病理类型及A1、A2及A3;P1、P2及P3病变部位。结果:46例资料完整的患者276个小叶被分析。在7个可以显示二尖瓣小叶分区定位的切面中,中食道五腔心切面、中食道四腔心切面、显示冠状静脉窦的短四腔切面、三腔心切面及结合彩色血流的胃底左心室短轴切面与术中发现的吻合率较高。结论:通过食道超声选择序列合理的切面可以在二尖瓣手术前进行较为准确的病变小叶分区定位,为外科手术,尤其是二尖瓣成形术提供必要的术前资料。
Objective： A pre-operation integrated assessment of mitral valve disease is a key to surgical decision-making and the outcoming. We sought to compare the accuracy of determined location of scallop lesions by transesophageal echocardiography （TEE） and the surgical findings, and identify the standard TEE views for detecting the location of scallop lesions. Method： Fifty three consecutive mitral valve （MV） prolapse patients with more than moderate mitral regurgitation （MR） referred for MV surgery were studied. AU the patients underwent TEE study to evaluate etiology for MV disease and the location of scallop lesions, and compare with surgical findings. The Carpentier nomenclature was applied to the mitral valve leaflets, three posterior leaflet scallops defined as lateral（ P1 ）, middle（P2）, medial（P3） ; and three anterior leaflet scallops defined as lateral（A1）, middle（A2）, medial（A3）. TEE studies were performed within one week of the surgery and during surgery, the mitral valve was examined using midesophageal four-chamber, midesophageal five-chamber, four-chamber with coronary sinus, two-chamber, two- chamber with eommissural, midesophageal long-axis of left ventrictdar, midgastrie short-axis of MV, midgastrie longaxis of left ventricular. The surgeons recorded the pathology of MV prolapse and ruptured ehordae, and the location of scallop lesions including A1 ,A2,A3 ,P1 ,P2,P3. Results： of the 53 patients referred to study, 46 had complete data for analysis. Total 276 scallops were studied. Of the 7 TEE views that can identify the location of scallop lesions, midesophageal five-chamber, midesophageal four-chamber, four-chamber with coronary sinus, midgastric long-axis of left ventricular, midgastric short-axis of MV combined with color Doppler had a excellent agreement with surgical findings.Conclusion： TEE is a good diagnostic evaluation tool to identify the location of scallop lesions using the different views before the MV surgery; it can provide the detailed information of MV repair.
出处
《心肺血管病杂志》
CAS
2009年第5期314-317,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
经食管超声心动图
二尖瓣反流
二尖瓣脱垂
二尖瓣小叶分区定位
Transesophageal echocardiography
Mitral regurgitation
Mitral valve prolapse
Location of mitral valve scallop
