经食管超声心动图在婴幼儿先心病手术中的应用

Intraoperative transesophageal echocardiography in infants with congenital heart disease

目的探讨经食管超声心动图(TEE)在婴幼儿先天性心脏病(先心病)手术中的应用及其价值。方法选取唐山市妇幼保健院小儿心胸外科2015年6月至2016年12月收治的由经胸超声心动图确诊并手术治疗的先心病患儿100例,对患儿应用TEE进行术中监测,了解手术即刻效果,及时纠正残留问题。结果所有患儿均顺利接受TEE检查,无并发症发生。TEE证实所有患儿术后心内排气充分,无明显残留气体。发现室间隔缺损残余分流3例,主动脉瓣微量反流1例,三尖瓣少量反流2例。其中1例室间隔缺损残余分流(直径>2 mm)术中再次行修补成功,2例室间隔缺损微量残余分流、1例主动脉瓣微量反流、2例三尖瓣少量反流对血流动力学无影响,未予处置。右室流出道疏通效果满意,主动脉窦瘤修补完好。术后1个月复查心脏彩超,2例室间隔缺损微量残余分流及1例主动脉瓣反流完全消失,2例三尖瓣少量反流无血流动力学意义,其余患儿均恢复良好。结论 TEE可以精准评估手术效果,提高婴幼儿先心病的手术成功率,是一种安全有效的监测手段。

Objective To explore the application and value of transesophageal echocardiography（TEE） in operation of infants with congenital heart disease（CHD）. Methods In cardiothoracic Surgery Department of Tangshan Maternity and Child Health Hospital from June 2015 to December 2016,intraoperative surveillance was conducted with transthoracic echocardiography in 100 CHD infants to evaluate the instant effect of operation and correct residual problems（residual shunts or valvular regurgitation） in time. Results All patients successfully underwent TEE examination without any complication. TEE confirmed that cardiac exhaust was full after operation,and no obvious residual gas was found in all patients. There were 3 cases of residual shunt of ventricular septal defect,1 case of aortic valve reflux,and 2 cases with three apex valve reflux in whom 1 case of ventricular septal defect with residual shunt（diameter 2 mm） received successful repair again,and no treatment was given in rest cases because there were no impacts on hemodynamics in them.The dredging of right ventricular outflow tract and the repair of aneurysm of the aortic sinus presented satisfactory results. At1 month after operation,re-examination of cardiac color Doppler ultrasound showed that the minimal residual shunt in 2 cases of ventricular septal defect,and aortic regurgitation in 1 case completely disappeared. There was no hemodynamic significance in 2 cases of a small amount of tricuspid regurgitation. The rest infants were well recovered. Conclusions Transesophageal echocardiography can accurately assess the effect of surgery and improve the success rate of congenital heart disease in infants. It is a safe and effective monitoring method.