经食道超声心动图在肺动脉闭锁合并室间隔完整外科治疗中的应用价值研究

Research on the role of transesophageal echocardiography in the operative procedures to pulmonary atresia with intact ventricular septum

目的评价经食道超声心动图(TEE)在肺动脉闭锁合并室间隔完整(PA/IVS)外科治疗中的应用价值。方法 79例PA/IVS为研究对象,分别在手术前、后行TEE检查。结果 2例患儿体外循环前经TEE确诊心肌窦样间隙开放而改变治疗方案。36例行双心室修复术,5例术后TEE证实肺动脉前向血流少,其中4例加行B-T术,1例加行Glenn术。11例行1心室修复患儿中,1例Glenn吻合口,1例B-T管道血流显示不清,但因患儿血流动力学稳定,未进行二次转流。15例行B-T术患儿,6例术后TEE示B-T血流显示不清,其中2例再行B-T分流术。10例行Glenn手术,1例因术后TEE示腔肺吻合口狭窄再行腔肺分流术。7例行Fontan手术,1例术后TEE示二尖瓣中度反流,再行二尖瓣整形。结论 TEE是一种安全、有效、实用的监测手段,值得在肺动脉闭锁合并室间隔完整外科治疗中推广应用。

Objective To evaluate the role of transesophageal echocardiography in accessing the operative outcomes of pulmonary atresia with intact ventricular septum.Methods Seventy-nine patients suffered pulmonary atresia with intact ventricular septum were underwent the transesophageal echocardiography examination before and after the operations.Results Two patients were diagnosed as myocardial sinusoids open by TEE before the extracorporeal circulation,their therapeutic regimen was changed.36 patients underwent two ventricle repair.5 cases was confirmed their pulmonary forward flow was limited,4 of them was added a B-T shunt,another one added a Glenn procedure.Among 11 patients who accepted one-and-half ventricle repair,anastomosis image in one Glenn shunt case and flow signal in one B-T shunt case was not clear,however,due to stable hemodynamics,further intervention was not practiced.6 cases in 15 patients who received Blalock-Taussig operations,did not have a clear display in TEE examination,2 of them received re-construction.1 case in 10 patients who underwent Glenn procedure,received reconstruction due to anastomosis stenosis displayed by the TEE.7 patients underwent Fontan procedure,1 of them received an additional mitral valvoplasty because of moderate mitral valve regurgitation demonstrated by TEE.Conclusions As a safe,effective and practical method,the TEE technique is worth popularizing in the operative procedures of pulmonary atresia with intact ventricular septum.