术中经食管超声心动图在全机器人膜周部室间隔缺损修补中的作用

Intraoperative Transesophageal Echocardiography in Robotic Perimembranous Ventricular Septal Defect Repair

目的探讨术中经食管超声心动图(transesophageal echocardiography,TEE)在全机器人膜周部室间隔缺损(ventricular septal defect,VSD)修补中的作用。方法对2009年1月至2012年8月间在我院接受全机器人膜周部VSD修补的18例住院患者的术中TEE资料进行回顾性分析。术中应用TEE的时间及目的:①体外循环(cardiopulmonary bypass,CPB)转机前,进一步明确VSD解剖类型、数目及大小,术者参考上述信息拟定手术方案;②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;③心脏复跳后,即刻评价心室水平有无残余分流及有无手术相关并发症。结果①以外科医生术中所见为标准,TEE诊断VSD解剖类型的准确性为100%,所有患者修补VSD均按术前拟定方案进行。②术中证实,所有患者下、上腔静脉内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%。③心脏复跳后,TEE显示所有患者心室水平均无残余分流,均无手术相关并发症,所有手术均获成功。结论术中TEE在全机器人膜周部VSD修补中是有益的诊断手段。

Objective To explore the role of intraoperative transesophageal echocardiography （TEE） in robotic perimembranous ventricular septal defect （VSD） repair. Methods A retrospective analysis was conducted with intraoperative TEE data of 18 consecutive patients who underwent robotic perimembranous VSD repair from January 2009 to August 2012.① Before cardiopulmonary bypass （CPB）, TEE was performed to document the anatomic types, numbers, and the size of VSD. The procedures were predetermined by the surgeon according to TEE information. ② During the establishment of peripheral CPB, TEE was used to guide the placement of cannulae in inferior vena cava （IVC）, superior vena cava （SVC）, and ascending aorta （AAO）. ③ After weaning from CPB, TEE was conducted to evaluate the effect of the procedure. Results④ Accuracy of TEE was 100% for diagnosing the anatomic types of VSD. All the surgical procedures were performed based on the predetermined information. ⑤Under TEE guidance, all the cannulae in the SVC, IVC and AAO were located in correct positions. ⑥ In all patients, TEE confirmed successful VSD repair. Conclusion TEE is a useful tool in the assessment of robotic perimembranous VSD repair.