2018 年第 3 期 第 13 卷

实时三维经食管超声心动图在经皮封堵人工瓣膜瓣周漏中的应用价值

Advantages of real-time three-dimensional transesophageal echocardiography in percutaneous closure of prosthetic paravalvular leakage

作者：李武华牛宝荣科雨彤李晓明吴山张纯

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单位：100029首都医科大学附属北京安贞医院超声心动图三部北京市心肺血管疾病研究所

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• 摘要：

• 目的    探讨实时三维经食管超声心动图（RT 3D-TEE）在经皮封堵人工瓣膜瓣周漏中的应用价值。方法    选取2015年12月至2017年2月在首都医科大学附属北京安贞医院经超声心动图检查诊断为人工瓣膜置换术后瓣周漏并同意经皮介入封堵术治疗的患者10例（共10个瓣周漏）。术前应用RT 3D-TEE及二维经胸超声心动图（2D-TTE）检查；术后即刻观察反流程度，术后3个月应用2D-TTE进行随访,观察短期内手术成功率及各项心脏超声指标变化情况。结果    RT 3D-TEE定位瓣周漏：5例位于9~12点位（前壁方向）内，4例位于3~6点位（后壁方向），1例位于6~9点位（侧壁方向）。2D-TTE对瓣周漏缺损最长径的测量值为（5.0±1.6）mm，与RT 3D-TEE的测量值(9.4±3.3)mm比较，差异有统计学意义（P＝0.001）。所有患者术后反流程度较术前明显减轻［（1.7±1.2）cm2比（7.3±2.8）cm2］（P＝0.019）。所有患者术后3个月左心室舒张末期内径、左心房直径、纽约心脏病协会心功能分级Ⅲ级比例均较术前明显降低［（57±8）mm比（58±8）mm、（55±17）mm比（57±17）mm、1/9比7/10］（均P＜0.05）。结论    超声心动图是评估瓣周漏的重要方法，RT 3D-TEE在评估瓣周漏形态、大小及指导选择封堵器上明显优于2D-TTE，可以为该类患者封堵器的选取提供必要信息。

• Objective    To investigate the advantages of real-time three-dimensional transesophageal echocardiography(RT 3D-TEE) in percutaneous closure of prosthetic paravalvular leakage（PVL）. Methods    Ten patients with PVL（totally 10 leakages） undergoing percutaneous closure therapy from December 2015 to February 2017 in Beijing Anzhen Hospital, Capital Medical University were enrolled. RT 3D-TEE and two-dimensional transthoracic echocardiography(2D-TTE) were performed before interventional procedure; 2D-TTE was used to observe the short-term surgery success rate and echocardiographic changes in 3 months. Results    RT 3D-TEE detected 5 PVLs at anterior location, 4 PVLs at posterior location and 1 PVL at lateral location. There was a significant difference between 2D-TTE and RT 3D-TEE in measuring the maximum diameter of leakage［（5.0±1.6）mm vs (9.4±3.3)mm］（P＝0.001）. Reflux degree significantly decreased after operation compared to that before operation in all patients［（1.7±1.2）cm2 vs（7.3±2.8）cm2］（P＝0.019）. Left ventricular end-diastolic dimension, left atrial diameter and the New York Heart Association classification of cardiac function grade Ⅲ ratio significantly reduced after operation compared to those before operation［（57±8）mm vs（58±8）mm, （55±17）mm vs（57±17）mm, 1/9 vs 7/10］（P＜0.05）. Conclusion    Echocardiography is a reliable tool for assessment of PVL; RT 3D-TEE is superior to 2D-TTE in measuring the form and size of PVL.