经食管超声心动图在急性Stanford A型主动脉夹层手术中的应用价值

Application value of transesophageal echocardiography in surgery of acute Stanford type A aortic dissection

目的探讨经食管超声心动图(TEE)在急性Stanford A型主动脉夹层(AAD)手术中的应用价值。方法选取经全主动脉CTA诊断为ADD的患者41例,术前均行TEE检查,根据TEE检出主动脉根部受累情况分为三组:夹层未累及主动脉根部16例(A组)、主动脉根部轻至中度受累9例(B组)及主动脉根部重度受累16例(C组)。观察各组主动脉根部形态、夹层受累情况(主动脉瓣叶形态、功能)及冠状动脉起始段形态,测量并比较各组主动脉瓣环内径、主动脉窦部内径、窦管交界内径及可显示升主动脉段的最大内径,术后TEE即刻观察手术效果。结果 41例患者术前TEE对升主动脉内撕裂的内膜片显示阳性率为100%。B、C组主动脉窦部内径均大于A组,C组主动脉窦部内径大于B组,差异均有统计学意义(均P<0.05);A、B、C组患者主动脉瓣环和升主动脉内径比较差异均无统计学意义。经手术证实,术前TEE诊断夹层累及冠状动脉的特异性为62.5%,敏感性为56.0%。术后TEE成功评估了人工主动脉瓣或修复主动脉瓣形态、功能,以及人工血管、冠状动脉等吻合情况。结论术前TEE能准确评估AAD主动脉根部及冠状动脉受累情况,术后TEE可即刻评估手术效果,具有重要的临床应用价值。

Objective To investigate the application value of transesophageal echocardiography（TEE） in surgery of acute Stanford type A aortic dissection（AAD）.Methods Forty-one patients diagnosed as AAD by aortic CTA were selected.TEE were performed before aortic surgery,then they were divided into three groups according to the aortic root involvement：group A including 16 cases,AAD without dissection involving aortic root,group B including 9 cases,AAD with mild to moderate dissection of aortic root,group C including 16 cases,AAD with severe dissection of aortic root.Aortic root form,involvement of the dissection（pattern and function of aortic valve）,morphology of the initial segment of the coronary artery were observed in three groups,inner diameter of aortic annulus,aortic sinus,the junction of the aortic sinus and displayable ascending aorta were measured and compared.TEE was used to observe the clinical effect immediately after the surgery.Results Forty-one patients showed dissection in their ascending aorta by preoperation TEE with the positive rate being 100%.Inner diameter of aortic sinus in group B and C were significantly higher than that in group A,while inner diameter of aortic sinus in group C was significantly higher than that in group B（all P0.05）.No statistically significant differences in diameter of aortic annulus was found among three groups.After surgery,the specificity and sensitivity of preoperative TEE in the diagnosis of coronary artery dissection were 62.5% and 56.0%.Postoperative TEE could evaluate the shape and function of the artificial aortic valve or repaired aortic valve,and the artificial blood vessel and coronary artery anastomosis also could be assessed by postoperative TEE.Conclusion Preoperative TEE can accurately assess aortic root and coronary artery involvement,it can evaluate the clinical effect immediately after the surgery,which has important clinical application value.