术中经食管超声心动图即刻评价前室间隔旷置手术切除左心室前壁室壁瘤对左心室形状、大小及功能的作用

Septal anterior ventricular exclusion operation for left ventricular anterior aneurysm：effects on left ventricular shape, volume and function by intraoperative transesophageal echocardiography

目的应用术中经食管超声心动图（TEE）即刻评价前室间隔旷置（septal anterior ventricular exclusion，SAVE）手术切除左室前壁室壁瘤对左室形状、大小及功能的作用。方法对20例拟用SAVE手术行心室几何重建（surgical ventricular restoration，SVR）的左室前壁室壁瘤患者进行前瞻性研究。全身麻醉诱导及气管插管后，将TEE探头插入食管中段。①体外循环（cardiopulmonary bypass，CPB）转机前，应用TEE充分了解室壁瘤的大小和位置，计算左室舒张末期球形指数（sphericity index，SI）；测量左室舒张末期容积指数（enddiastolic volume index，EDVI）、收缩末期容积指数（end-systolic volume index，ESVI）及射血分数（ejection fraction，EF）。②心脏复跳后，评价补片缝合位置及残留左室腔大小，计算SI、EDVI、ESVI及EF，并将其与CPB转机前比较。结果SVR术后，左室形状更接近椭圆形，SI从0．76±0．04增加至0．84±0．05（P〈0．001）；左室大小更接近正常，EDVI从（121．51±16．91）ml／m^2减小至（60．27±9．93）ml／m^2（P〈0．001），ESVI从（85．81±15．02）ml／m^2减小至（32．44±5．36）ml／m^2（P〈0．001）；左室整体收缩功能明显改善，EF从（29．52±6．06）％增加至（46．02±3．90）％（P〈（1．001）。结论对于左室前壁室壁瘤，SAVE手术可使成形后的左室形状更接近椭圆形，使增大的左室恢复正常大小，从而明显改善左室整体收缩功能。

Objective To assess the effects of septal anterior ventricular exclusion（SAVE） procedure on left ventricular（LV） shape, volume and function in patients with post-infarction LV anterior aneurysm by intraoperative transesophageal echocardiography （TEE）. Methods Twenty patients with LV anterior aneurysm underwent surgical ventricular restoration（SVR） with the SAVE procedure. Intraoperative TEE was performed before cardiopulmonary bypass（CPB） and after weaning from CPB. LV volume and ejection fraction（EF） was measured using the biplane Simpson＇s method. LV end-diastolic and end-systolic volumes,indexed by body surface area （EDVI and ESVI, respectively） were calculated. To estimate the shape of LV, end-diastolic sphericity index （SI） of LV was determined. Results Compared with pre- CPB,after SVR, LV shape became more elliptical： SI increased from 0.76 ± 0. 04 to 0. 84 ± 0.05, P 〈0. 001. LV size became more normal： EDVI decreased from （121.51 ± 16.91）ml/m^2 to （60.27 ± 9.93）ml/m^2 , P〈0.001 ,and ESVI decreased from （85.81 ± 15.02）ml/m^2 to （32.44 ± 5.36） ml/m^2 , P 〈0. 001 , respectively. EF was increased significantly： （46.02 ± 3.90） % vs （29.52 ± 6.0） %, P 〈0. 001. Conclusions The SAVE technique is easy to reshape LV to ellipsoid form and normal size and the resultant improved configuration may contribute to improving EF for patients with post-infarction LV anterior aneurysm.