经食管超声心动图在主动脉瓣重建术中的应用价值

Evaluation of the intraoperative transesophageal echocardiography for the aortic valve reconstruction

目的探讨经食管超声心动图在主动脉瓣重建术中的应用价值。方法总结2014年10月至2016年10月期间，在北京安贞医院进行主动脉瓣重建术的19例患者（男15例，女4例，年龄12～65岁，平均年龄37.7岁）术中经食管超声心动图特征及随访结果。结果新生主动脉瓣经食管超声心动图表现：瓣叶略增厚，回声稍强，以瓣叶交界处和3个瓣叶的汇合点最为明显。主动脉瓣微量反流9例，轻度反流1例，9例未见反流信号。2例术后即刻超声评价主动脉瓣流速增快。与术前即刻比较，术后即刻升主动脉内径[（32.7±6.1）mm比（36.4±6.3）mm，P〈0.001]、左室内径[（48.3±6.1）mm比（59.1±7.3）mm，P〈0.001]减小，主动脉瓣对合长度明显增加[（6.6±1.3）mm比（2.2±0.7）mm，P〈0.001]，差异均有统计学意义。术后即刻主动脉瓣平均流速（175 cm/s）略高于术后3个月时平均流速（165 cm/s），但差异无统计学意义（P＝0.367）。1例于术后15 d出现重度主动脉瓣反流，其术后即刻为轻度反流；2例术后12个月时出现重度主动脉瓣反流。结论经食管超声心动图能够准确评价主动脉瓣重建术的术后效果。

ObjectiveTo explore the value of the intraoperative transesophageal echocardiography during the aortic valve reconstruction.Methods The echocardiographic features were retrospectively summarized in 19 patients （male： 15 cases; female： 4 cases; age ranged from 12 to 65 years, mean age： 37.7 years） with aortic valve reconstruction at Beijing Anzhen Hospital between October 2014 and October 2016.ResultsThe findings of the neo-aortic valve on the transesophageal echocardiography included the slightly thickened and hyperechogenicity of the commission, especially the central coaptation point of the neo-valve. Trace aortic regurgitation was noted in 9 cases after operation, mild aortic regurgitation in 1 case and no aortic regurgitation in 9 cases. The velocity of the aortic valve increased significantly in 2 cases. Compared with pre-operation, the diameter of ascending aorta[（32.7±6.1） mm vs （36.4±6.3） mm, P〈0.001]and the inner diameter of left ventricle[（48.3±6.1） mm vs （59.1±7.3） mm, P〈0.001]decreased significantly after operation, the coaptation length of aortic valve[（6.6±1.3） mm vs （2.2±0.7） mm, P〈0.001]significantly increased than that of pre-operation. The mean immediate velocity after operation （175 cm/s） was slightly higher than that （165 cm/s） of 3-month follow-up after surgery, but with no significant difference （P=0.367）. Severe aortic regurgitation was found 15 days after operation in 1 case and 12 months after operation in 2 cases.ConclusionIntraoperative transesophageal echocardiography is a useful tool to evaluate the result of the aortic valve reconstruction.