食管超声心动图评价围术期儿童法洛四联症的右室流出道

Perioperative transesophageal echocardiographic evaluation of right ventricular outflow tract in children with tetralogy of Fallot

目的 运用经食管超声心动图（TEE）对儿童法洛四联症（TOF）的右室流出道（RVOT）情况进行围术期评价。方法 32例TOF病儿体外循环前后分别进行TEE检查，年龄4个月～15岁8个月，平均4．0岁。结果 术前32例均TEE诊断为TOF。31例行根治术，1例行B-T分流术。RVOT扩大补片15例；跨肺动脉瓣环补片（TAP）16例，包括4例切除肺动脉瓣，2例带瓣移植物重建RVOT。术后TEE诊断RVOT残余梗阻5例（16．1％），与是否采用TAP无关（X^2=1．115，P=0．291）。肺动脉反流（PR）16例（51．6％），采用TAP比扩大补片术后更易出现PR（X^2=14．212，P=0．000）。保留原肺动脉瓣可减轻术后PR程度（X^2=5．915，P=0．015）。带瓣移植物重建RVOT可减少术后PR（X^2=8．163，P=0．004）。结论 术前TEE可明确诊断TOF，术后TEE可评价不同手术方法对于RVOT的效果。

Objective To evaluate the condition of right ventrieular outflow tract （RVOT） during perioperative period by transesophageal eehoeardiography （TEE） in children with tetralogy of Fallot （TOF）. Methods TEE was performed in 32 patients withTOF, aged from 4 months to 15.7 years （mean4.0years）, duringperioperativepefied. Results TOF was onnfirmed by TEE preoperative in all 32 cases. Thirty-one cases underwent radical surgery, while 1 ease underwent B-T shunt. Transannular patch （TAP） was carried out in 16 eases and enlargement patch in 15 eases to relieve RVOT obstruction. Among patients received TAP, pulmonary valves were cut off in 4 cases and RVOT was reconstructed with bovine jugular xenograft valved conduit （Contegra） in 2 cases. Postoperative TEE showed residual RVOT obstruction in 5 cases （ 16.1% ）. Residual obstruction was not correlated with TAP. （ X^2 = 1. 115, P = 0.291 ）. Pulmonary regurgitation （PR） was observed in 16 cases （51.6 % ）. The patients with TAP were more apt to PR after operation than those with only enlargement patch （ X^2 = 14.212, P = 0.000）. Preservation of the original pulmonary valve could alleviate the degree of PR （ X^2 = 5.915, P = 0.015）. Reconstruction of RVOT with valved implant could reduce the occurrence ofPR（X^2=8.163, P=0.004）. Conclusion TEE is a useful tool during perioperative period. It is able to diagnese TOF precisely before operation and to evaluate the impact to RVOT with different procedures.