经食管二维超声心动图在二尖瓣成形术中的应用

The Clinical Application of Two-dimensional Transesophageal Echocardiography in Mitral Valve Repair

目的探讨经食管二维超声心动图(two-dimensional transesophageal echocardiography,2D-TEE)在二尖瓣成形术(mitral valve repair,MVR)中的临床应用价值。方法 40例二尖瓣关闭不全拟实施MVR患者,应用2D-TEE在术前对二尖瓣病变的病因进行诊断,术中监测,术后即刻评估瓣膜返流程度。结果二尖瓣关闭不全的病因有:瓣膜黏液样退行性病变19例(47.50%),先天性二尖瓣病变10例(25.00%),感染性心内膜炎病变5例(12.50%),风湿性瓣膜病变4例(10.00%),缺血性病变导致二尖瓣关闭不全2例(5.00%)。40例患者中35例1次性手术成功,3例术后监测发现中度返流,再次行成形术终获成功,2例术后仍为重度返流改行二尖瓣人工瓣膜置换术。左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室舒张末期容量(LVEDV)、左心室收缩末期容量(LVESV)、左心室射血分数(LVEF)均较术前降低(P<0.05)。结论 MVR术中应用2D-TEE有助于手术方式的选择及手术效果的评价。

Objective To illuminate the clinical application value of two -dimensional transesophageal echo- cardiography（2D -TEE） in preoperative diagnosis, intraoperative monitoring and postoperative efficacy in mi- tral valve repair （MVR）. Methods The data from transthoracic echocerdiography in patients （ n = 40） who would take MVR in General Hospital of Ningxia Medical University were retrospectively analyzed. The impor- tance of the preoperative diagnosis of pathogeny for the choice of surgical option in MVR was illuminted. 2D - TEE was performed to evaluate the effect of the mitral valve repair immediately. The results of two - dimension- al transthoracic echocardiography before and after 1 week surgery in patients were compared. Results The cafises of mitral insufficiency were as followed： 19 cases （47.50%） with degenerative disease, 10 cases （25.00%） with congenital lesions, 5 cases （12. 50% ） with subactLte bacterial endocar ditis, 4 cases （ 10.00% ） with rheumatic valve disease and 2 cases （ 5.00% ） with ischemic mitral insufficiency. Of 40 pa- tients, 3~5 patients completed successfully surgical operations in one time while 3 patients had moderate regur- gitation after operation and 2 patients underwent mitral valve replacement because of severe regurgitation. LAD,LVEDD, LVESD, LVEDV, LVESV and LVEF were significantly red iced compared with those in preoper- ation（ P 〈 0.05 ）. Conclusion Degenerative diseases were the most co nmon cause of adult mitral valve in- sufficiency. The findings from 2D -TEE could help surgeon choose the b est surgical option according to differ- ent pathogeny in MVR.