经食管超声心动图在主动脉夹层术中的应用

The role of transesophageal echocardiography in surgical treatment of aortic dissection

目的评价经食管超声心动图(TEE)在主动脉夹层术中的应用价值。方法对62例(其中DeBakeyⅠ型53例,DeBakeyⅡ型9例)确诊并将行开胸术的主动脉夹层患者,术前采用TEE评价主动脉瓣解剖结构、有无内膜撕脱及其范围、破口位置、升主动脉内径及夹层分型。术后即刻评价主动脉瓣、人工机械瓣及人工血管的功能情况。结果62例患者合并主动脉瓣关闭不全45例。TEE准确评估升主动脉内径大小、内膜撕脱情况、破口位置、主动脉瓣结构及反流情况、真假腔情况,同时显示假腔内血栓。根据TEE在术前提供的诊断信息,采取主动脉瓣不处理、主动脉瓣成形术、David术及人工机械瓣置换术。术后即刻评估手术效果,主动脉瓣成形术后效果理想20例,不理想4例；David术后效果理想4例,不理想1例；人工机械瓣功能良好20例,有瓣周漏1例。结论TEE在主动脉夹层术前提供诊断信息,术中指导手术操作,术后评价手术效果。

Objective To evaluate the role of transesophageal echocardiography （TEE） in the surgical treatment of aortic dissection. Methods A total of 62 patients with aortic dissection prepared for operation were investigated by preoperative transesophageal echocardiography. Of them 53 cases had DeBakey Ⅰ aortic dissection and 9 had DeBakey Ⅱ aortic dissection. Preoperative TEE was performed to confirm the pre-surgical diagnosis and to provide information on the anatomy of the aortic valve, the location and size of the tearing entry, the diameter of the ascending aorta and the classification of the dissection. Immediately after the operation the functions of the aortic valve and the artificial valve and artificial blood vessels were evaluated by TEE in the same way. Results Of the 62 patients, 45 had concomitant aortic valve insufficiency. The TEE allowed a precise evaluation of ascending aorta diameter, aortic valve structure and reflux, and optimal visualization of intimal flap and tearing entry with a fine distinction between true and false lumen as well as thrombosis in the false lumen. Based on the preoperative information of TEE, no treatment of aortic valve, aortic valvoplasty, David procedure and artificial valve substitution were performed. Immediate evaluation of operative effects was as follows. Of the cases who underwent aortic valvoplasty, 20 had optimal effects and 4 cases, sub-optimal effects ; of those who underwent David procedure, 4 cases achieved optimal effects and 1 case, sub-optimal; the 20 artificial valves functioned well with only 1 case demonstrating perivalve leak. Conclusion Transesophageal echocardiography plays an important role in surgical treatment of aortic dissection.