经食管超声心动图在儿童复杂性先天性心脏病手术治疗中的应用价值

Value of transesophageal echocardiography in monitoring surgical repair of pediatric patients with complex congenital heart disease

目的探讨经食管超声心动图(TEE)对儿童复杂性先天性心脏病(CHD)手术治疗的价值。方法复杂性CHD患者95例,年龄0.3～15.6岁(平均4.3岁),均在体外循环前后进行TEE检查。结果术前TEE首要诊断与手术诊断符合率100%,其中仅7例(7.4%)TEE次要诊断与手术诊断不符。TEE对经胸超声心动图诊断做出补充或修正9例(9.5%),其中6例(6.3%)由于TEE的发现而作出手术方案改变或相应处理。术后TEE成功显示率95.8%(91/95),在91例显示成功患者中,达到预期效果且无残余问题63例(69.2%),发现残余问题28例(30.8%),其中2例(2.2%)由于TEE的发现立即予以处理。结论术前TEE可准确诊断儿童复杂性CHD,有助于制定手术方案,术后TEE可及时发现残余问题,有助于提高手术成功率。

Objective To evaluate the role of transesophageal echocardiography （TEE） in surgical repair of children with complex congenital heart disease （CHD）. Methods Ninety-five patients aged 0. 3-15.6 years old （average 4.3 years） with complex CHD were examined by TEE before and after cardiopulmonary bypass. Results Preoperative TEE was perfectly in accordance with surgical findings on major heart defects. However, only 7 cases （7.4%） were not in accordance with the minor heart defects. TEE complemented or amended the diagnosis of transthoracie echocardiography in 9 cases （9.5%）, among which operative schemes of 6 cases （6.3 %） were altered accordingly due to the TEE findings. Postoperative TEE images were acquired in 91 cases （95. 8%）, among which anticipated goal was attained in 63 cases （69.2%）, while residual problems in 28 cases （30. 8% ） were detected by postoperative TEE. Two cases of them （2.2%） were undergone revises due to the TEE findings before the end of operation. Conclusion TEE is a useful tool in precisely diagnosing complex CHD in children. TEE plays an important role in establishing operative scheme before operation, is also meaningful in detecting residual problems after operation.