经食管三维超声在心血管疾病手术中的应用价值

Application value of real-time three-dimensional transesophageal echocardiography in the surgery for cardiovascular disease

目的探讨经食管实时三维超声心动图(RT-3D-TEE)在心血管疾病手术中的应用价值。方法对接受经导管主动脉瓣置换术(TAVI)、经心尖二尖瓣机械瓣瓣周漏封堵术、外科经皮房间隔缺损封堵术及二尖瓣成形术的8例患者应用RT-3D-TEE进行术前超声诊断和术中监测,并与外科术中所见进行比较,术后即刻评价手术效果。结果 8例患者术前RT-3D-TEE均能清晰、立体地显示病变部位、大小、程度及其与周围组织的关系,可以明确诊断,并选取适宜的人工瓣膜型号或封堵器型号。超声三维重建显示的病变结构与术中所见高度相符,RT-3D-TEE术中监测显示8例患者的手术均取得成功,且术后未见明显的并发症。结论 RT-3D-TEE通过三维重建能实时、动态地再现心脏的立体解剖结构,更为直观、准确地显示房室瓣、房间隔、室间隔及病变部位等微细结构,在心血管疾病手术中有重要作用。

Objective To investigate the application value of real-time three-dimensional transesophageal echocardiography（RT-3D-TEE）in the surgery for cardiovascular disease.Methods Eight patients who received transcatheter aortic valve implantation（TAVI）,transapical closuer of paravalvular leak,percutaneous transcather closuer of atrial septal defect,and surgical mitral valvuloplasty were included. RT-3D-TEE was use for the preoperative diagnosis and intraoperative monitoring,and the findings was compared with what was observed during the operation. The therapeutic effect was evaluated immediately after the surgery.Results The location, size and the degree of the lesion could be clearly displayed by RT-3D-TEE, and relationship between the lesion with surrounding tissue could be assessed, which provided definite information for diagnosis and choosing appropriate types of artificial valve and amplatzer. The structure constructed by RT-3D-TEE was highly consistently with what was shown during the operation. The operation was successful in all 8 patients without obvious complications as monitored by RT-3D-TEE after the operation.Conclusion Through the three-dimensional reconstructed images,RT-3D-TEE could dynamically reproduce the stereo-anantomic structure of heart, intuitively and accurately display the microstructure of artrioventricular valve, atrial septum, ventricular septum and lesion. It plays an important role in the development of surgery for cardiovascular disease.