胸主动脉病变术中应用经食管超声心动图的初步探讨  

Preliminary Experience of Intraoperative Transesophageal Echocardiography in Thoracic Aortic Diseases

作　　者：袁定华 李守平[1] 杨浣宜[1] 刘汉英[1] 刘玉清[1] 孙立忠[1] 常青 朱俊明[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所,中国医学科学院中国协和医科大学阜外心血管病医院

出　　处：《中国循环杂志》1996年第2期76-78,共3页Chinese Circulation Journal

摘　　要：目的：探讨胸主动脉疾病的术中应用经食管超声心动图（ＴＥＥ）的价值及适应证。方法：本文报道８例（１５～６３岁，平均年龄４４．５岁）不同类型胸主动脉疾病术中ＴＥＥ监测结果。病例包括先天性主动脉瓣上狭窄、升主动脉瘤、主动脉夹层及主动脉夹层伴假性动脉瘤、胸降主动脉假性动脉瘤、主动脉瓣脱垂等。结果：８例患者的术中检查与术前诊断全部吻合。术中ＴＥＥ发现１例主动脉夹层累及左锁骨下动脉，而术前磁共振成像未能提示。此外，术中ＴＥＥ还显示２例胸降主动脉内的粥样硬化斑块。结论：初步显示术中ＴＥＥ可即刻评价手术效果，对拟行主动脉瓣成形术的患者最有价值；为避免升主动脉粥样斑块的脱落导致术后体循环尤其是脑栓塞，对于高龄患者也积极提倡术中ＴＥＥ监测。Objective: The diagnostic value of transesophageal echocardiography(TEE) in thoracic aortic diseases as been proved by several clinical studies. The purpose of the present study was to evaluate the value of intraoperative TEE in thoracic aortic diseases. Methods: Intraoperative TEE was performed on 8 patients (44. 5 yrs., 15-63 yrs.) who had different types of aortic diseases, including ascending and descending aortic aneurysm, aortic dissection, false aortic aneurysm, congenital supravalvular aortic stenosis, congenital aortic valve regurgitation, etc. Results: The assessment of intraoperative TEE showed good agreement with the preoperative diagnosis in all of the 8 cases. In one case with aortic dissection, intraoperative TEE revealed the involvement of left subclavian artery, which had been neglected by MRI before surgery. Intraoperative TEE also detected protruding atherosclerotic plaques in the thoracic aorta of two cases. Conclusions: Our preliminary experience suggests that intraoperative TEE might allow the surgeon to evaluate and refine the operative technique by immediate feedback on the operative results which is especially important in aortic valve repair. And it is also useful for older patients in reducing the incidence of cerebral stroke related to atheromatous embolization.

关 键 词：经食管 超声心动图 胸主动脉疾病 外科手术 

分 类 号：R543.105[医药卫生—心血管疾病] R654.3[医药卫生—内科学]