食管超声在室间隔缺损修补术中的应用体会

Analysis and experience of application of transesophageal echocardiography in surgical treatment to patients with ventricular septal defect

目的探讨经食管超声心动图在室间隔缺损修补术中的应用价值与经验。方法2012年3月至2013年9月，我院先天性心脏病矫治术中共有259例应用食管超声心动图，其中复杂型先心病57例（房室间隔缺损6例、法洛四联症33例、右心室双出口3例、大动脉转位5例、肺动脉闭锁9例、主动脉弓中断1例），单纯VSD202例。记录术后残余分流发生率，残余分流的位置、大小、分流速度。结果①术中食管超声发现14例残余分流，术后复查新发现残余分流1例，共15例。②术中使用食管超声后，术后1周残余分流发生率为1．56％，术后3个月残余分流发生率O．79％。结论①术中使用食管超声能够明显减少术后残余分流发生率。②术中食管超声发现的残余分流直径≤2mm且左向右分流流速〈3m／s者，不需要二次手术。

Objective To evaluate the clinical value and find experience of application of trans- esophageal echocardiography in cardic surgical treatment. Methods Between Feb 2012 and Sep 2013, 259 patients with congenital heart disease were operated, which the transesophageal echoeardiography were applied in the process of operation. The surgical processes were monitored, and the surgical outcomes were evaluated and recorded in the process of operation. Results （1） 14 cases of residual shunt were diagnose and corrected timely. （2）After the transesophageal echocardiography was applied, the rate of residual shunt were 1.56% on 1 week after operation, and the rate of residual shunt were 0.79% on 3 month after operation. Conclusion （1） The TEE in cardiac surgeries can evaluate the occurrence and prognosis residual shunt timely, and enhance rate surgical success. （2）When the size of residual shunt were no more than 2 mm and the velocity of transsep- tal flow shunt were no more than 3 m/s, we could affirm the operation of repairing ventricular septal defect were successful.