摘要
目的:探讨经食管实时三维超声心动图(RT-3DETEE)评价Stanford A型主动脉夹层(AD)患者主动脉根部的临床价值。方法:选取2018年3月—2022年4月于深圳市宝安区人民医院行StanfordA型AD外科手术治疗患者26例,术前均进行经胸超声心动图(TTE)、CT血管成像(CTA)、手术室全麻后RT-3DE TEE观察主动脉瓣形态、功能,冠状动脉开口,测量主动脉瓣环、窦部、窦管交界、升主动脉最宽内径,并与手术结果比较;术后即刻RT-3DE TEE观察主动脉瓣或人工瓣、人工血管等。结果:CTA不评价主动脉瓣反流,TIE、RT-3DE TEE评估主动脉瓣反流程度敏感性、特异性差异均无统计学意义(P>0.05),而准确率差异具有统计学意义(P <0.05)。TIE、CTA、RT-3DE TEE检测AD根部冠状动脉开口显示率、检测冠状动脉受累敏感性、特异性差异均无统计学意义(P> 0.05),而准确率差异具有统计学意义(P<0.05)。三种方法测量主动脉瓣环内径、窦管交界内径差异均无统计学意义(P> 0.05);而窦部内径、升主动脉内径差异均有统计学意义(P<0.05)。且术后RT-3DETEE能及时准确评估主动脉瓣或人工瓣形态、功能,人工血管、冠状动脉等手术效果。结论:RT-3DETEE能准确评估StanfordA型AD患者围手术期主动脉根部、冠状动脉受累情况,术后即刻评估手术效果,可用于TIE及CTA的补充,具有重要临床应用价值。
Objective To investigate the clinical value of real-time three-dimensional transesophageal echocardiography(RT-3DE TEE)in evaluating the aortic root of Stanford type A aortic dissection(AD).Methods 26 patients underwent Stanford type A AD surgical treatment at Shenzhen Baoan People's Hospital from March 2018 to April 2022 were selected.Preoperative transthoracic echocardiography(TTE),CT angiography(CTA)and RT-3DE TEE before general anesthesia in the operating room were performed to observe the morphology and function of aortic valve,the coronary artery ostium,and the inner diameter of the aortic valve ring,sinus,junction of the sinus tube and ascending aorta were measured,and compared with the results of operation.Aortic valve,prosthetic valve and prosthetic vessel were immediately observed by RT-3DE TEE after surgery.Results The degree of aortic regurgitation wasn't assessed by CTA,there was no significant difference between TTE and RT-3DE TEE in the sensitivity and specificity in evaluating the degree of aortic regurgitation(P>0.05),while the accuracy rate difference was statistically significant(P<0.05).There was no significant difference among TTE,CTA and RT-3DE TEE in detecting the display rate of coronary artery ostium,sensitivity and specificity in detecting coronary artery involvement in AD(P>0.05),while the accuracy difference was statistically significant(P<0.05).There was no significant difference in aortic annular diameter and sinus tube junction diameter measured by three methods(P>0.05),while the diameter of sinus and ascending aorta difference was statistically significant(P<0.05).RT-3DE TEE can timely and accurately evaluate the morphology and function of aortic valve and prosthetic valve,and the effect of prosthetic vessel and coronary artery.Conclusion RT-3DE TEE can accurately assess the perioperative aortic root and coronary artery involvement in patients with Stanford type A AD,and can evaluate the surgical effect immediately after operation,which can be used as a supplement to TTE and CTA,and has important clinical application value.
作者
陈明
米雪
宋鑫
程起
相广财
CHEN Ming;MI Xue;SONG Xin;CHENG Qi;XIANG Guangcai(Department of Ultrasound,Shenzhen Baoan People's Hospital,Shenzhen,Guangdong 518101,China)
出处
《影像研究与医学应用》
2023年第17期7-11,共5页
Journal of Imaging Research and Medical Applications
基金
深圳市宝安区科技局(2020JD414)。
