心外膜彩色多普勒超声在三尖瓣成形术中的应用

Application of Intraoperative Color Doppler Echocardiography in Tricuspid Valve Prosthesis

目的 评价术中心外膜超声心动图 (IEE)在三尖瓣成形术 (TVP)中的作用。方法 对 17例风湿性心脏病 (RHD)换瓣术并 TVP患者在术中体外循环前后用 IEE对三尖瓣的形态和功能进行评价以指导 TVP。结果 体外循环前 IEE新发现 3例患者伴左房血栓 ,1例伴卵园孔未闭 ,1例伴动脉导管未闭 ,另 1例经 IEE提示作了补救性 TVP,避免了二次开胸。全组患者术后即刻在 1～ 2周后三尖瓣环直径、三尖瓣返流束长度 ,面积及其与右房长度面积比值均显著减少 (P<0 .0 1)。结论 IEE在 TVP中具有重要应用价值。

Objective To evaluate the application of intraoperative epicardial echocardiography(IEE) in tricuspid valve prosthesis.Methods A total of 17 patients with rheumatic heart disease(RHD) who underwent cardiac valve replacement and tricuspid valve prosthesis(TVP) were performed IEE before and after cardiopulmonary bypass,and the morphology and function of the tricuspid valve were evaluated Results Three patients were found with thrombi in the left antrum before cardiopulmonary bypass;one patient with patent foramen ovale and one patient with patent ductus arteriosus before cardiopulmonary bypass;one patient had anomalies with different tricuspid regurgitation(TR) after cardiopulmonary bypass All patients were re operated immediately The annular diameter,the lengths(L) and areas(A) of the TR and of the right atrium(RA) were measured before and 1 2 weeks after TVP The ratios of TR L to RA L and of the TR A to RA A were significantly reduced after operation compared to the preoperative measurements( P <0 01) Conclusions IEE technique possesses the important value in TVP