经食管探头行心外膜超声在心脏外科手术中的应用研究

Novel use of transesophageal echocardiographic probe for intraoperative epicardial imaging in cardiac surgery

目的探讨经食管心外膜超声心动图在心脏外科术中监测的操作方法,探索其在多种心脏外科手术中的具体应用价值。方法采用GE公司经食管多平面超声探头,体外循环开放并复跳后行经食管心外膜超声心动图对53例心脏手术患者行术中监测,提供瓣膜功能情况、左心室收缩功能、有无残余分流等信息。结果 53例患者均在体外循环复跳后行经食管心外膜超声检查获得满意的图像,无感染、出血、严重心律失常等并发症。5例患者发现左心室壁节段性运动异常给予及时处理;1例患者发现换瓣后机械瓣周残余分流再次转机后分流消失;1例患者三尖瓣成形术后仍为中量反流再次成形反流量减少;2例患者发现室间隔修补术后即刻评价术后残余分流再次修补分流消失。1例肥厚型心肌病左心室流出道梗阻患者,即刻评估流出道血流速度超过正常范围(3.2 m/s),再次转机手术后流速下降为1.4 m/s,压差降低为8 mmHg(1 mmHg=0.133 kPa)。结论经食管心外膜超声心动图具有操作简便、准确的优势,能够即刻评价手术疗效,在心脏外科手术中具有显著发展前景和重要临床应用价值。

Objective To evaluate the clinical application value of epicardial transesophageal echocardiography （ETE） in cardiac surgeries. Methods Using the transesophageal multi-plane ultrasonic probe of GE company, ETE were performed for a total of 53 patients undergoing cardiac surgeries with extracorporeal circulation and heart re-beat, evaluating valvular function, left ventricular systolic function and residual shunts. Results Qualiifed ETE images were obtained in all of the 53 cases without complications of infection, bleeding and serious arrhythmia. Intraoperative regional left ventricular systolic dysfunction happened in 5 cases and was promptly handled. Residual mitral regurgitation after valvular replacement was found in one case, which was reduced by valvuloplasty. One case showed moderate tricuspid regurgitation and another two cases indicated residual shunt. All the problems in the above cases were corrected in immediate surgeries. Moreover, the pressure gradient of one hypertrophic obstructive cardiomyopathic patient fell significantly to 8 mmHg after successful myectomy （the blood flow velocity fell from 3.2 m/s to 1.4 m/s）. Conclusion Epicardial transesophageal echocardiogramphic examination is easy to handle and useful in monitoring abnormalities in cardiac surgery by providing hemodynamic and anatomic information.