术中经食管超声心动图在全机器人二尖瓣修复术中的作用

Intraoperative evaluation of robotic mitral valve repair by transesophageal echocardiography

目的 探讨术中经食管超声心动图（TEE）在全机器人二尖瓣修复术（MVR）中的作用.方法 对24例因重度退行性二尖瓣反流（MR）行全机器人MVR的患者行术中TEE检查.应用TEE在体外循环（CPB）转机前明确MR病变原因及病变部位;建立外周CPB时,引导下、上腔静脉插管及升主动脉内心脏停搏液灌注针的置放;心脏复跳后.即刻评价有无残余MR及有无手术相关并发症.结果 以外科所见为标准,TEE诊断退行性MR病变原因及病变部位均有较高的准确性,分别为93.1%和98.6%;TEE引导下,所有患者下、上腔静脉插管及升主动脉内灌注针均放置于适当位置.TEE引导置管成功率为100%;TEE证实所有患者手术均获成功.无残余MR及手术相关并发症.结论 术中TEE在全机器人MVR术中必不可少.

Objective To explore the utility of intraoperative transesophageal echocardiography （TEE） in robotic mitral valve repair （MVR） with the da Vinci system. Methods Intraoperative TEE was performed in 24 patients undergoing robotic MVR for severe degenerative mitral regurgitation （MR）between September 2007 and February 2010. Before cardiopulmonary bypass （CPB） ,TEE was performed to document the mechanism and location of degenerative MR. During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava （IVC）,superior vena cava （SVC）,and ascending aorta （AAO）. After weaning from CPB, TEE was performed to evaluate the effect of the procedure. Results Accuracy of TEE was 93.1% for the mechanism of degenerative MR, and 98.6% for the localization of the prolapsed leaflets. All the cannulae in the SVC,IVC and AAO were located in correct position. In all patients, TEE confirmed successful repair with no residual insufficiency and no procedurerelated complications. Conclusions In robotic MVR, TEE have important roles as follows： providing the reliable diagnostic information before CPB, guiding placement of the cannulae in the IVC, SVC, and AAO correctly during establishment of peripheral CPB determining the competency of MVR immediately after CPB. TEE is important for robotic MVR.