Comparativeanalysis Of Transesophageal Two-dimensional And Three-dimensional Echocardiography In Diagnosis And Quantitative Evaluation Of Perivalvular Leakage Of Artificial Aortic Valve

【Objectives】With the aging of the population,the increasing number of valvular heart lesions,coupled with the continuous development of medical technology,valve surgery and interventional minimally invasive treatment have increased year by year,and the detection rate of postoperative perivalvular leakage has also increased.Ultrasound is an important means for the diagnosis of perivalvular leakage,and this study compares the diagnostic and quantitative evaluation value of 2D-TEE and 3D-TEE in the diagnosis and quantitative evaluation of aortic valve PVL,and discusses the risk factors of PVL after aortic valve replacement,aiming to provide a reference for clinical diagnosis and treatment and immediate evaluation of surgical effect during surgery.【Methods】The hospital medical record system and image report system were used to collect 16 patients who underwent aortic valve replacement in the cardiac surgery department of our hospital from January 2019 to December 2022 and were found to have PVL in TEE.In addition,21 patients who underwent aortic valve replacement in our hospital during the same period and did not develop PVL were selected as the control group.The preoperative clinical data and ultrasound characteristics of the two groups were compared,and the predictive value of each risk factor on PVL after aortic valve replacement was retrospectively analyzed.The Philips EPIQ 7C ultrasound diagnostic instrument was used to collect 2D-TEE and 3D-TEE images of PVL patients,and the detection of PVL number,position,shape,retraction neck width,circumferential range of regurgitation and leakage area of PVL were compared by the two methods.Finally,whether there was a difference between Ao-a,Ao-s,Ao-asc,LAD,LVDD,LVDS,AV,CO,LVEF and patients without PVL after surgery in patients with aortic PVL were analyzed.【 Results 】(1)Univariate analysis showed that there were significant differences between patients in the study group and control group in the comparison of PASP and calcification(P<0.05).These two variables were included in the multivariate logistic regression analysis,and the results showed that aortic valve calcification(OR=0.083,95% CI 0.009-0.791,P<0.05)was an independent influencing factor affecting the occurrence of aortic valve PVL.The area under the ROC curve is 0.731,the sensitivity and specificity are 0.938 and 0.524,respectively,and the cut-off value is 0.5.(2)16PVL patients were examined by 2D-TEE in one bundle;The aortic PVL locations of2D-TEE were located in 11 places(64.7%)without pericoronary valve,4(23.5%)in the right pericoronary valve,and 2(11.8%)in the left pericoronary valve.The degree of PVL diagnosed was moderate in 2 cases and mild in 14 cases.RT 3D-TEE was examined in 15 patients with PVL in one place and 1 patient with 2 PVL.RT 3D-TEE diagnosed PVL in 2 cases(11.8%)in the direction of 10-11 points,4 cases(23.5%)in the direction of 12-1 points,1 case(5.9%)in the direction of 2-5 points,2 cases(11.8%)in the direction of 7-8 points,2 cases(11.8%)in the direction of 7-9 points,4 cases(23.5%)in the direction of 8-9 points,and 2 cases(11.8%)in the direction of 9-10 points.RT 3D-TEE showed that PVL morphology was crescent in 8 places(47.1%),oval in 5 places(29.4%),slit shape in 2 places(11.8%),and irregular shape in 2 places(11.8%).Twelve cases were diagnosed with mild PVL,4 cases were moderate PVL and re-arrest repair,and the intraoperative findings were consistent with the diagnosis of RT3D-TEE,3 cases of PVL disappeared after surgery,and 1 case turned into mild PVL.(3)The width of the leakage retraction neck,the circumferential range of perivalvular regurgitation,and the leakage area detected by RT 3D-TEE were higher than those measured by 2D-TEE,and the differences were statistically significant(P <0.05)。(4)One month after surgery,13 PVL patients were followed up,5 cases of PVL disappeared,8 patients still had mild PVL,13 PVL patients were compared with Ao-a,Ao-s,Ao-asc,LAD,LVDD,LVDS,AV,CO,LVEF after valve replacement,and the differences were not statistically significant(P>0.05).【Conclusions】1、Aortic valve calcification is an independent risk factor for postoperative PVL in patients undergoing aortic valve replacement which has certain value in predicting the occurrence of postoperative PVL.2、In the diagnosis of prosthetic aortic valve perivalvular leak compared with 2D-TEE,3D-TEE can more accurately display the number,location,and morphology of aortic valve PVL,quantitatively assess its size and severity,and has a certain guiding value for clinical management of PVL.