超声心动图在激光心肌血运重建术前后的诊断价值及临床意义

Diagnosis worth and clinical significance of echocardiography in perioperation and follow up of the transmyocardial laser revascularization

目的 总结超声心动图 (UCG)在 5 0例激光心肌血运重建术 (TMLR)围术期及随访期应用的经验与体会。方法 术前均采用HP SONOS 2 0 0 0型超声分析仪通过体表超声 (TTE)重点观察室壁运动 ,左室收缩与舒张功能及二尖瓣反流等情况。比较 3 6例心血池和UCG所测左室射血分数 (LVEF)。术中通过食道超声 (TEE)二维图像上出现激光汽化心肌组织所产生的气泡证实打孔有效。术后分别于 3、6、12个月复查UCG ,并采用AcusonSequoia电脑声像仪观察激光孔道通畅情况。结果 术前TTE示左室壁运动普遍减低者 8例 ,节段性减低者 3 0例 ;二尖瓣轻度反流者 15例 ,中度反流者 3例。UCG与心血池所测LVEF值无显著性差异 ( P >0 .0 5 )。术中TEE所示打孔有效率为 93 .6%。无 1例出现因打孔造成的二尖瓣反流。术后 3、6、12个月LVEF值均较术前有所提高 ,但无统计学意义。术后 ( 7.0± 2 .4)个月彩色多普勒速度图 (CDV)示激光孔道存在 ,孔道形状呈现直线型、角型、八字型、钩型及斜线型等多样化。频谱多普勒 (PW )测定孔道的血流可得到不同形状的频谱。结论 应用UCG技术可以在TMLR术前、术中和术后对心肌缺血部位的定位、心功能、乳头肌功能、打孔瞬间成功与否、孔道通畅、孔道与心肌内冠状动脉相沟通与否。

Objective To review the experiences of echocardiographic application in perioperation and follow up of transmyocardial laser revascularization(TMLR) in 50 patients.Methods Before operation,the regional wall movement,the systolic and diastolic function of left ventricle,and the severity of mitral regurgitation were observed by transthoracic echo cardiography with HP SONOS 2000 ultrasonic equipment.The average of left ventricular ejects fractions(LVEF) measured by SPECT were compared with those by UCG in 36 ptients.During operation,detection of intraventricular microbubbles by transesophageal echocardiography(TEE) was interpreted as confirmation of the transmural penetration.The follow up was performed on 3, 6 and 12 months postoperatively.The patency of laser channels was observed by Acuson Sequoia computed sonography.Results Eight cases were preoperative hypokinesis of global left ventricular wall,30 cases were regional hypokinesis and 15 cases were slight and 3 cases were mild mitral regurgitation.There were no significant difference(P> 0.05 ) between the LVEF measured by echo and by SPECT. 93.6 % creating rate of transmyocardial channels were verified by TEE during operation.There were no mitral regurgitation caused by TMLR in any cases.Although all of the LVEF value at postoperative 3,6 and 12 months were improved,these increases were not significant in the statistics.The color Doppler velocity demonstrated the presence of the laser channel at ( 7.0 ± 2.4 ) months postoperatively.The type of the channel looked like straight line,angular,chinese number of eight,hook or slanting,etc.The pulse wave Doppler can detect the blood flow of the channel and obtain the spectrum with different shapes.Conclusions Echocardiography could detect the location of ischemic myocardium,the cardiac and papillary muscles function,the success of penetration,the presence of the channel and its connection with intramyocardial coronary arteries,the formation of the new net of vassels surrounding the laser channels,before,during and after TMLR.