经食管超声心动图在急诊二次瓣膜置换术中的应用

Multi-transesophageal echocardiography in detecting dysfunction of replaced mechanical prosthetic valve during emergency reoperatio

目的 急诊二次瓣膜置换是挽救人工瓣膜功能急性障碍患者的唯一方法 ,本文探讨多平面经食管超声心动图 (MTEE)在急诊二次瓣膜置换术中监测及疗效评价。方法 经胸超声心动图 (TTE)分别诊断为二尖瓣位机械瓣环撕裂伴大量瓣周漏1例、主动脉瓣位人工机械瓣卡瓣1例患者 ,在急诊二次换瓣手术中 ,作者用MTEE进行术前、术中及术后监测 ,总结MTEE特点及应用。 结果 全麻后MTEE检查 ,1例为主动脉瓣位机械瓣急性狭窄伴关闭不全 ,CW估测跨主动脉瓣收缩期压差110mmHg,彩色多普勒血流显像 (CDFI)示重度主动脉瓣反流 ,为人工金属主动脉瓣卡瓣 ;1例为二尖瓣位机械瓣环与前叶根部见1.6cm的回声缺失 ,为人工金属二尖瓣撕裂伴大量瓣周漏。在二次瓣膜置换术、心脏复跳后进行MTEE检查 ,瓣膜功能良好后关闭胸腔。2例二次急诊瓣膜置换均成功。结论 与TTE比较 ,术前MTEE检查可更正确判断人工瓣膜功能急性障碍病变的性质和程度 ;闭胸前进行MTEE检查可及时、正确判断瓣膜手术效果 ,不干扰手术视野、避免再次开胸。建议在急诊瓣膜置换术中 ,常规进行MTEE监测 。

Objective To explore the diagnosis of multi-transesophageal echocardiography(MTEE)in detecting dysfunction of replaced mechanical prosthetic valve during emergency reoperation. Methods Before,during and after the emergency reoperation ,detected the replaced mechanical prosthetic valve by MTEE . Results With the MTEE, the diagnosis were insufficiency of aortic replaced mechanical prosthetic valve because of its mechanical valve disorder; and severe perivalular leakof mitral replaced mechanical valve prostheses because of its mechanical valve avulsion .Conclusion MTEE was a reliable tool for detecting the function and blood flow dynamic of replaced mechanical prosthetic valve and MTEE can more accurately detect the abnormal location and extent of replaced mechanical prosthetic valve.