超声心动图在激光心肌打孔血运重建术中的作用

Initial Experience with Use of Echocardiography in the Operation of Transmyocardial Laser Revascularization

对８例有陈旧性心梗（ＯＭＩ）并不稳定心绞痛的患者进行激光打孔血运重建术（ＴＭＬＲ）术前、术中及术后的超声心动图评估。术前ＴＴＥ发现８例患者均有与ＯＭＩ报道部位一致的节段室壁运动异常。５例术前行多巴酚丁胺负荷超声（ＤＳＥ）检查，２例小剂量负荷时有室壁运动改善，３例在大剂量时，发现新的节段室壁运动异常或原有室壁运动异常加重。术中ＴＥＥ检查５例，监测打孔成功率７５％。术后随访，虽然所有存活患者临床症状明显改善，但复查超声静息状态下未发现ＬＶＥＦ及室壁运动指数的明显改善，这可能与ＴＭＬＲ治疗后仅导致心内膜下亚区域心肌灌注改善有关。

Eight patients with OMI and unstable angina received the operation of transmyocardial laser revascularization (TMLR). Echocardiography was performed before, during and after the operation respectively. Before operation, by TTE, all 8 patients were found to have regional abnormal wall motion of the left ventricle concordant with the reported site of OMI. Among 5 cases with dobutaminestress echocardiography examination before TMLR, 2 patients had improvement of the abnormal ventricular wall motion at a low dose stress, and 3 patients had new abnormal wall motion or worsened previous abnormal wall motion at a high dose stress. The success rate of myocardial laser perforation detected by TEE in operation was 75%. With a 2￣12 months post operation followup, although all survived patients had obvious improvement clinically, the LVEF and WMSI evaluated at rest didn't improve in echocardiography. The mechanism is not clear now, but it is thought this phenomenon may be related to the subregional myocardial perfusion improvement of the endomyocardium after TMLR.