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目的探讨经食管三维超声心动图定位左心房内黏液瘤的准确度及重要性,初步分析造成二尖瓣口梗阻的影响因素。方法全部患者进行常规或术中经食管三维超声心动图检查,确定黏液瘤附着在左心房的位置,所得结果对比手术所见。结果经食管三维超声心动图显示左心房黏液瘤附着于房间隔卵圆窝18例、心房顶壁(无冠窦后方)4例、心房后壁3例、心耳1例,对比手术所见准确度达100%。黏液瘤造成二尖瓣口梗阻16例,无梗阻10例,梗阻组瘤体长径、(瘤体/基底)径线比值、二尖瓣口速度、肺动脉收缩压力间均较无梗阻组高。结论经食管三维超声心动图能准确定位左心房黏液瘤,对外科选择术式十分重要。瘤体附着位置、瘤体长径及基底(蒂)宽径为影响二尖瓣口梗阻的相关因素。
Objective To investigate the accuracy and importance of transesophageal echocardiography in the localization of left atrial myxoma and to analyze the influencing factors of mitral valve obstruction. Methods All patients underwent routine or intraoperative esophageal three-dimensional echocardiography to determine the location of myxoma attached to the left atrium. The results obtained were compared with surgical findings. Results The transesophageal echocardiography showed that the left atrial myxoma adhered to the septal fossa in 18 cases, to the apical wall (without posterior coronary sinus) in 4 cases, to the atrial appendage in 3 cases, to the atrial appendage in 1 case. The accuracy of the surgical findings Up to 100%. Myxoma caused mitral valve obstruction in 16 cases, obstruction in 10 cases, obstruction group tumor diameter, (tumor / basal) diameter ratio, mitral valve velocity, pulmonary artery systolic pressure were higher than non-obstructive group. Conclusion Esophageal three-dimensional echocardiography can accurately locate the left atrial myxoma, which is very important for surgical selection. The location of the tumor, the long diameter of the tumor and the width of the base (pedicle) are the related factors that affect the mitral valve obstruction.