摘要
目的探讨经食管超声心动图(TEE)在直视微创二尖瓣外科手术中的应用价值。方法选择行心脏外科直视微创二尖瓣手术患者150例,男57例(38.0%),女93例(62.0%),平均年龄(50.6±13.5)岁。术前超声诊断二尖瓣中重度返流116例,二尖瓣重度狭窄18例,二尖瓣返流合并狭窄14例,机械瓣瓣周漏2例。参照心外科Carpentier瓣膜分区法确定病变位置,制定手术方案,术中TEE监测下建立体外循环,右侧胸腔前外侧小切口,行直视下微创二尖瓣手术。心脏复跳后TEE监测心脏排气、测量瓣口相关参数评估手术疗效。结果术中TEE再次评价瓣膜病变后修改手术方案8例。二尖瓣成形术49例,二尖瓣人工瓣膜置换62例,二尖瓣置换+三尖瓣人工瓣环成形术36例,二尖瓣置换+冠状动脉搭桥1例,二尖瓣人工机械瓣周漏修补术2例。49例瓣膜成形术患者术前、术后二尖瓣返流面积分别为(11.19±5.31)cm^2和(1.21±0.31)cm^2(t=18.213,P<0.05),返流束缩流颈宽度分别为(7.48±2.75)mm和(1.07±0.51)mm(t=7.320,P<0.05),瓣口面积分别为(4.67±1.49)cm^2和(3.58±1.13)cm^2(t=1.104,P>0.05),瓣口最大跨瓣压差分别为(3.07±1.11)mm Hg和(3.81±1.44)mm Hg(t=-0.748,P>0.05)。二尖瓣成形术后TEE评价2例疗效不满意改为人工瓣膜置换术。62例人工瓣膜置换术后均无瓣周漏。结论TEE在直视微创二尖瓣术前评价瓣膜情况、引导体外循环的建立、术后监测心内排气、评价手术疗效等方面具有引导和评估作用,为手术的成功提供重要保障。
Objective To discuss the value of transesophageal echocardiography （TEE） in the minimally invasive mitral valve operation. Methods Totally 150 patients were performed minimally invasive mitral operation, 57 males and 93 female, mean age was （50.6 ＋ 13.5 ） y. Severe mitral regurgitation were found in 116 patients, severe mitral stenosis were found in 18 patients, severe mitral regurgitation combined stenosis were found in 14 cases, 2 cases had mechanical prosthetic paravalvular leakage. Referring to Carpentier method to determine the lesion location, TEE was performed for venous cannula- tion guidance and building the extracorporeal circulation, completing the mitral valvular operations by the right anterolateral minithoractomy through the 4th intercostals. Assess the effective deairing, cardiac function and the results of operation by the TEE at the time of weaning from cardiopulmonary bypass （CBP）. Results Mitral valve repair （MVP） in 49, mitral valve re- place （MVR） in 98, MVR associated CABG in 1 case, repairing the perivalvular leakage in 2 cases （ beating heart）. In MVP 49 cases, mitral regurgitation area, vena contracta width, orifice area and maximum pressure grade across mitral orifice were （11.19± 5.31）cm2 vs. （1.21 ＋0.31）cm2（ t =18.213, P 〈0.05）, （7.48±2.75） mm vs. （1.07 ±0.51）mm （ t = 7. 320, P 〈0.05）, （4.67 ±1.49） cm2 vs. （3.58 ±1.13）em2（ t = 1. 104, P 〉0.05）, （3.07 ±1. ll）mm Hg vs. （3.81 ±1.44） mm Hg （ t = 0. 748, P 〉 O. 05 ） preoperative and postoperative respectively. Two cases of MVP were changed to MVR, because of unsatisfied efficacy evaluated by TEE. 62 cases of MVR had no paravalvular leakage. Conclusion TEE is usefulin guiding placement of the building of CPB, evaluating valve structure and the cardiac, function and deairing detection during minimal invasive mitral valve operation.
出处
《疑难病杂志》
CAS
2014年第8期783-786,共4页
Chinese Journal of Difficult and Complicated Cases
基金
北京市科委资助"首都市民健康项目培育"(No.Z111107067311038)
关键词
超声心动图
经食管
二尖瓣手术
微创瓣膜手术
术中监测
Eehoeardiography, transesophageal
Minimally invasive
Minimally invasive valve operation tive monitoring
作者简介
通信作者：杨娅，E-mail：echo-mn@163．com
