术中经食管超声心动图对心脏瓣膜置换术后即刻人工瓣膜功能异常的诊断价值

Diagnostic Value of Transesophageal Echocardiography on Acute Intraoperative Prosthetic Valve Dysfunction

目的:探讨术中经食管超声心动图对心脏瓣膜置换术后即刻人工瓣膜功能异常的诊断价值。方法:回顾性分析2011年4月至2016年9月我院心脏瓣膜置换术后即刻急性人工瓣膜功能异常患者11例资料,总结术中经食管超声心动图结果,并与手术结果进行对照分析。结果:11例患者中,机械瓣置换术8例,生物瓣置换术3例。术中经食管超声心动图显示,瓣膜功能异常包括人工瓣膜梗阻(7例)及瓣膜关闭不全(4例)。术中经手术证实,人工瓣膜梗阻原因包括:残留血栓、残留腱索、保留二尖瓣后叶、主动脉瓣下隔膜、机械瓣离体瓣叶开放受限;人工瓣膜关闭不全原因包括:生物瓣瓣叶脱垂、缝线勒住生物瓣瓣脚及瓣膜内源性因素。11例患者再次接受手术,其中6例更换新的人工瓣膜,其余5例去除梗阻原因,所有患者均未再次出现人工瓣膜功能异常,住院期间无患者死亡。结论:经食管超声心动图可及时确认心脏瓣膜置换术后即刻人工瓣膜功能异常,协助判别内源性因素并指导外科补救。

Objectives:To evaluate the diagnostic value of transesophageal echocardiography(TEE)on acute intraoperative prosthetic valve dysfunction(AIPVD).Methods:Clinical data of 11 patients with AIPVD,hospitalized in our hospital from April 2011 to September 2016,were retrospectively analyzed,and the imaging findings of TEE were compared to the surgical results.Results:Eight patients received mechanical prosthetic valve replacement and 3 received bioprosthetic valve replacement.Acute prosthetic valve dysfunction including 7 obstruction and 4 regurgitation were confirmed by intraoperative TEE.The reasons causing obstruction included left atrial thrombus,residual chord tendineae,reserved posterior mitral leaflet,subaortic membrane,and prosthetic valve technology problem.The reasons causing prosthetic valve insufficiency included bioprosthetic aortic valve prolapse and the suture line hanged the strut and other intrinsic reason.All patients received second surgical procedures.New prosthetic valve replacement was performed in 6 patients and obstruction abnormality were successfully removed in the others 5 individuals.No valve abnormalities were observed after re-surgeries and all patients were recovered and discharged without further complications.Conclusions:Intraoperative TEE can be used for the diagnosis of acute prosthetic valve dysfunction and is helpful to define the intrinsic reason in the operation room,which is a valuable tool aiding the decision making for surgeons to target and correct the prosthetic valve dysfunction.