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RT 3D-TEE在二尖瓣置换术后瓣周漏的诊断及介入封堵和外科手术治疗对照分析 |
李师淼,李冰震,易弼顺,田锋,马柏强 |
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(丽水市人民医院急诊创伤外科) |
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摘要: |
目的:探讨经食管实时三维超声心动图(RT 3D-TEE)在二尖瓣置换术后瓣周漏(PVL)的诊断价值及介入封堵和外科手术治疗效果。方法:选取2018年5月至2020年6月诊治的105例二尖瓣置换术后疑似PVL患者作为研究对象,经手术确诊(金标准)为二尖瓣置换术后PVL共56例(后叶漏34例、前叶漏22例),并在术前予以食管二维超声心动图(2D-TEE)和RT 3D-TEE检查,对比阳性预测值、阴性预测值、PVL漏口位置检出率及漏口长度、宽度、面积;评估2D-TEE、RT 3D-TEE诊断PVL的AUC值、敏感度、特异度;并根据治疗方法分为介入封堵组(n=28)和外科手术组(n=28),对比手术时间、住院费用、住院时间、输血率、肺部感染率、新发心律失常率、残余PVL率、左心室射血分数(LVEF)、左心室舒张末期内径(LVIDd)、左心室收缩末期内径(LVIDs)、左心房内径(LVD)。结果:105例二尖瓣置换术后疑似PVL患者经2D-TEE检查后,阳性预测值72.22%,阴性预测值66.67%,与金标准相比,一致性较差(Kappa=0.389,P<0.001);经RT 3D-TEE检查后,阳性预测值为96.43%,阴性预测值为95.92%,与金标准相比,一致性较好(Kappa=0.923,P<0.001)。其中,2D-TEE检出率与RT 3D-TEE比较,差异具有统计学意义(χ2=4.102,P<0.05)。RT 3D-TEE检出后叶漏、前叶漏占比高于2D-TEE,且漏口长度、漏口宽度、漏口面积高于2D-TEE(P<0.05)。ROC曲线分析显示,2D-TEE、RT 3D-TEE诊断PVL的AUC值分别为(0.690、0.955,P<0.05)。介入封堵组的手术时间、住院费用、住院时间及输血率、肺部感染率、新发心律失常率均低于外科手术组(P<0.05)。介入封堵组的LVEF、LVIDd、LVIDs、LVD与外科手术组相比,差异无统计学意义(P>0.05)。结论:RT 3D-TEE在二尖瓣置换术后PVL诊断中具有较高的准确率,且采用介入封堵术治疗效果显著,安全性高。 |
关键词: RT 3D-TEE 二尖瓣置换术 瓣周漏 介入封堵 外科手术 |
DOI: |
投稿时间:2022-05-07修订日期:2022-06-15 |
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RT 3D-TEE in the diagnosis of paravalvular leakage after mitral valve replacement and a comparative analysis of interventional closure and surgical treatment |
Zhou Chunlai,Li Bingzhen,Yi Bishun,Tian Feng,Ma Baiqiang |
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Abstract: |
Objective: To investigate the diagnostic value of transesophageal real-time three-dimensional ultrasound (RT 3D-TEE) in the diagnosis of paravalvular leak (PVL) after mitral valve replacement and the effect of interventional closure and surgical treatment. Methods: A total of 105 patients with suspected PVL after mitral valve replacement who were diagnosed and treated from May 2018 to June 2020 were selected as the research subjects. A total of 56 patients with PVL after mitral valve replacement were diagnosed by surgery (34 cases of posterior leaflet leakage, 34 cases of anterior leaflet Two-dimensional transesophageal ultrasonography (2D-TEE) and RT 3D-TEE were performed to compare the positive predictive value, negative predictive value, detection rate of PVL leak location, and the length, width and area of the leak. The AUC value, sensitivity and specificity of 2D-TEE and RT 3D-TEE in the diagnosis of PVL; they were divided into interventional occlusion group (n=28) and surgical operation group (n=28) according to the treatment method, and the operation time, hospital stay were compared Cost, length of hospital stay, blood transfusion rate, pulmonary infection rate, new-onset arrhythmia rate, residual PVL rate, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), Left atrial diameter (LVD). Results: After 2D-TEE examination of 105 patients with suspected PVL after mitral valve replacement, the positive predictive value was 72.22% and the negative predictive value was 66.67%. Compared with the gold standard, the consistency was poor (Kappa=0.389, P<0.001); After RT 3D-TEE examination, the positive predictive value was 96.43%, and the negative predictive value was 95.92%, which was consistent with the gold standard (Kappa=0.923, P<0.001). Among them, the detection rate of 2D-TEE was significantly different from that of RT 3D-TEE (χ2=4.102, P<0.05). RT 3D-TEE detected a higher proportion of posterior lobe leak and anterior lobe leak than 2D-TEE, and the leak length, leak width and leak area were higher than those of 2D-TEE (P<0.05). ROC curve analysis showed that the AUC values of 2D-TEE and RT 3D-TEE for the diagnosis of PVL were (0.690, 0.955, P<0.05), respectively. The operation time, hospitalization cost, hospitalization time, blood transfusion rate, pulmonary infection rate, and new-onset arrhythmia rate in the interventional closure group were lower than those in the surgery group (P<0.05). There was no significant difference in LVEF, LVIDd, LVIDs, and LVD between the interventional occlusion group and the surgery group (P>0.05). Conclusion: RT 3D-TEE has a high accuracy in the diagnosis of paravalvular leakage after mitral valve replacement, and the interventional occlusion is effective and safe. |
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