| 摘要: |
| 目的 研究三维经食管超声心动图(three-dimensional transesophageal echocardiography,3D-TEE)在评估人工机械瓣膜血管翳的狭窄程度中的应用价值。方法 选取2019年10月-2023年3月在我院经食管超声心动图诊断为人工瓣膜血管翳,并且经手术证实的病例46例,其中人工二尖瓣血管翳22例,人工主动脉瓣血管翳24例。观察人工瓣血管翳在3D-TEE上的成像特征,在三维图像上测量血管翳面积、瓣环内侧缘面积与瓣环外侧缘面积之比、血管翳宽度与瓣膜外径之比(pannus width/valve external diameter,W/D)等相关参数,经胸超声心动图( transthoracic echocardiography,TTE)上测量平均跨瓣压差(the mean transaortic pressure gradient,mTPG),分析并比较血管翳的三维测量参数与mTPG的相关性。结果 ①3D-TEE结果显示当血管翳环绕人工瓣环的角度在大于等于180°时更容易引起瓣口的明显狭窄,角度大小对瓣口狭窄程度的影响具有显著性差异(p<0.05)。②对于人工主动脉瓣膜,三维图像上测得的瓣环内侧缘面积与瓣环外侧缘面积之比(0.33±0.08)、血管翳W/D(0.41±0.09)、血管翳面积(1.79 ±0.68)cm2 均与mTPG(44.13±13.59)mmHg具有良好的相关性,相关性分别为R=-0.782,P<0.001,R=0.820,P<0.001,R=0.741,P<0.001。对于人工二尖瓣膜,人工二尖瓣瓣环内侧缘面积与瓣环外侧缘面积之比(0.31±0.07)、血管翳W/D(0.35±0.09)、血管翳面积(1.88 ±0.71)cm2 均与人工二尖瓣mTPG(13.87±6.59)mmHg具有良好的相关性,相关性分别为R=-0.793,P<0.001,R=0.878,P<0.001,R=0.806,P<0.001。③人工二尖瓣血管翳相关参数与mTPG的相关性优于人工主动脉瓣。结论 3D-TEE在评估人工瓣膜血管翳的梗阻程度方面具有重要价值,尤以W/D指标能更准确地评估瓣膜的梗阻程度。3D-TEE在人工二尖瓣血管翳梗阻程度的评估价值优于人工主动脉瓣。 |
| 关键词: 三维经食管超声心动图 人工瓣血管翳 瓣膜梗阻 |
| DOI： |
| 投稿时间：2023-10-11修订日期：2023-11-24 |
| 基金项目:陆军军医大学临床医学科研人才培养计划（2018XL3040) |
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| the value of three-dimensional transesophageal echocardiography in evaluating obstruction of artificial mechanical valve pannus |
| YU PU,ZUO HAO,DUAN MAO,GUAN XUE,YIN YA FEI,XU MIN,LI QING LONG,XU YA LI |
| () |
| Abstract: |
| Objective: To investigate the efficacy of three-dimensional transesophageal echocardiography (3D-TEE) in evaluating the extent of stenosis in pannus on artificial mechanical valves. Methods: A total of 46 cases with pannus on the prosthetic heart valve diagnosed via transesophageal echocardiography (TEE), confirmed surgically in our hospital between October 2019 and March 2023, were recruited. This cohort included 12 cases of pannus on the prosthetic mitral valve and 22 cases of pannus on the prosthetic aortic valve. The 3D-TEE imaging characteristics of pannus were observed, and various parameters were measured, including pannus area, the ratio of the areas of the medial and lateral edges of the annulus, and the ratio of the pannus width to the valve external diameter (W/D). Additionally, the mean transvalvular pressure gradient was measured via transthoracic echocardiography (TTE). The study analyzed and compared the correlation between these parameters of the pannus and the mean transvalvular pressure gradient (mTPG). Results: ① The 3D-TEE results revealed that a pannus angle encompassing the prosthetic valve annulus, equal to or exceeding 180°, was associated with a higher likelihood of pronounced stenosis in the valve orifice. The angle size was significantly associated with the degree of stenosis (P < 0.05). ② In prosthetic aortic valves, it was found that the three key measurements - the ratio of the areas of the medial and lateral edges of the annulus being 0.33±0.08, W/D of the pannus at 0.41±0.09, and the area of the pannus being 1.79±0.68 cm2 - strongly correlated with the mTPG of 44.13±13.59 mmHg. The correlation coefficients for these combined parameters were R=-0.782, P<0.001, R=0.820, P<0.001, and R=0.741, P<0.001, respectively. In artificial mitral valves, it was observed that the concurrent presence of the following three measurements - the ratio of the areas of the medial and lateral edges of the annulus at 0.31±0.07, the W/D of the pannus at 0.35±0.09, and the area of the pannus at 1.88±0.71 cm2 - significantly correlated with the mTPG of 13.87±6.59 mmHg. The combined correlation coefficients for these parameters were R=-0.793, P<0.001, R=0.878, P<0.001, and R=0.806, P<0.001, respectively. ③The correlation between parameters related to the pannus in prosthetic mitral valves and the mTPG gradient was stronger compared to that in prosthetic aortic valves. Conclusion: 3D-TEE is valuable for assessing the extent of stenosis in pannus on prosthetic valves. Particularly, the pannus W/D index can accurately assess the degree of valve obstruction. The study suggests that 3D-TEE is more valuable for evaluating the degree of pannus obstruction in prosthetic mitral valves than that of prosthetic aortic valves. |
| Key words: three-dimensional transesophageal echocardiography artificial valve pannus valvular obstruction |
