目的:评估经食管超声及彩色血流显像对人工机械瓣膜正常及病理性反流的诊断价值。方法:分析
2004 － 05 ～ 2014 － 02 期间经TTE 及TEE 检查的人工机械瓣资料完整的病例52 例，男25 例，女27 例，平均年龄
44． 66 ± 5． 09岁，其中二尖瓣位置机械瓣置换数52 个，主动脉瓣位置机械瓣置换数27 个，双瓣置换的重叠病例
18 例。二尖瓣位机械瓣反流分级标准以反流口缩流宽度划分。主动脉瓣位机械瓣的偏心性反流分级标准以Jet
宽/LVO 宽度划分，瓣周漏分级以漏口彩色血流占瓣环周长比率划分。结果:(1) 二尖瓣替换病人，TTE 显像诊
断人工机械瓣二尖瓣正常及病理性反流的准确性为59． 62%，低估率为28． 85%，高估率为36． 54%，漏检率为
19． 23%。(2)主动脉瓣替换病人，TTE 诊断人工机械主动脉瓣正常及病理性反流的准确性为85． 18%，低估率
11． 1%，高估率为14． 81%。结论:TEE 在评价人工机械瓣膜病理性反流方面尤其是对人工心脏机械瓣二尖瓣的
评价优于经胸超声，起到了明确诊断的决定性作用。

Objective:The aim of this study was to evaluate the diagnostic value of transesophageal
echocardiography on normal and pathological regurgitation of prosthetic mechanical heart valve． Methods:
Fifty － two patients were participated in the research，including twenty － five males and twenty －
seven females at an average age of 44． 66 ± 5． 09． Patients with prosthetic mechanical heart valve in single
mitral(n = 52)，single aortic( n = 27)，and mitral and aortic( n = 18) positions were examined by
transthoracic echocardiography(TTE) and transesophageal echocardiography ( TEE)． The standards of
mitral regurgitation of prosthetic mechanical heart valve were assessed by the width of the vena contracta．
The standards of aortic eccentric regurgitation were assessed by Jet /LVO width and aortic perivalvular
leakage by the ratio of CDFI to perimeter of the aortic annulus respectively． Results:(1)Mitral re-
placement(including bivalve replacement):The accuracy in assessment of normal and pathological regurgitation
of prosthetic mechanical heart valve by transthoracic echocardiography(TTE)was 59． 62%;
underestimation rate was 28． 85%; overestimation rate was 36． 54%; evade detection rate was
19． 23%． (2)Aortic replacement(including bivalve replacement):The accuracy in assessment of normal
and pathological regurgitation of prosthetic mechanical heart valve by transthoracic echocardiography(
TTE)was 85． 18%;underestimation rate was 11． 1%;overestimation rate was 14． 81%． Conclusion:
In the assessment of pathological regurgitation of prosthetic mechanical heart valve，especially
in terms of mitral regurgitation，transesophageal echocardiography(TEE) is superior than transthoracic
echocardiography(TTE)，which plays a decisive role in definite diagnosis．

R445． 1

 收稿日期:2013 － 12 － 19;修回日期:2014 － 04 － 06
基金项目:内蒙古自治区科技厅应用技术资助项目(20120401)
作者简介:南晓彦(1963 － )，女，内蒙古自治区人民医院主任医师。