术中经食管超声心动图在左室室壁瘤外科处理中的应用  

Application of Intraoperative Transesophageal Echocardiography to the Surgical Treatments of Left Ventricular Aneurysm

作　　者：叶赞凯[1] 夏明钰[1] 王浩[1] 凤纬[2] 段福建[1] 霍顺伟[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院超声科,北京市100037 [2]中国医学科学院中国协和医科大学阜外心血管病医院外科,北京市100037

出　　处：《中国超声医学杂志》2008年第4期321-323,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的旨在研究术中经食管超声心动图(IOTEE)在左室室壁瘤外科处理中的应用价值。方法选取我院确诊为左室室壁瘤并行外科处理的37例患者为研究对象,均为左室心尖部室壁瘤,患者平均年龄为(56.80±9.44)岁,所有的患者的心功能分级(NYHA)均为级或级;在回顾研究系列中所有患者,同时应用IOTEE来评价他们转机前后的心室容量,二尖瓣功能,左室心尖部血栓及其它;评价室壁的功能和存活性来引导切割和成形手术,另外还包括搭桥手术;35例巨大室壁瘤先行左室心内膜环缩成形术,然后线性缝合。结果术中经食管超声心动图发现2例室壁瘤不典型,未处理,余35例患者经确诊均为典型的左室心尖部的巨大室壁瘤,术前左室的射血分数是(0.33±0.12)10例患者有轻中度的二尖瓣反流,4例患者有中度的二尖瓣反流,同时2例患者合并中到重度的二尖瓣和主动脉瓣的反流。伴随的手术过程包括2例的双瓣置换术。在住院和随访中有2例患者死亡。对比术前和术后的参数,左室收缩末期容积(69±18vs42±16)ml,(P<0.05);左室的舒张末期容积(118±51vs79±25)ml,(P<0.05),左室的射血分数(0.33±0.12vs0.40±0.14)。同时还发现根据IOTEE,14例患者中有12例患者(86%),二尖瓣反流有了明显的改善,均不足少量,余有2例患者进一步进行了成形处理,反流也为少量。结论术中经食管超声心动图在左室室壁瘤的外科处理中发挥着重要的指导作用。Objective To assess the applications of intraoperative transesophgeal echocardiography （IOTEE） in the surgical treatments of the left ventricular aneurysm. Methods From April 2004 to April 2006, there were 37 cases with large apical aneurysm who were underwent aneurysmectomy in our hospital. The mean age of patients was 56.80± 9.44 years old. All the patients were in NYHA heart function class statusⅢ or Ⅳ. We reviewed our series of patients who underwent the procedure with in the past two years and we used the IOTEE to evaluate their pre- and post- CPB ventricular volume and function, mitral valve function, thrombosis in the apex of the left ventricle, and etc. The wall function and viability to guide resection and repair of the aneurysm were assessed. Additional procedures included coronary artery bypass grafting. Thirty-five cases underwent ventricular endoaneurysmorrhaphy first and then linear left ventricular aneurysmectomy procedure. Results Two aneurysms were detected atypical on IOTEE, and surgical treatemnt was avoided. The other 35 cases were identified large apical aneurysm on the IOTEE. The pre- operative left ejection fraction was 0.33±0. 12%. Ten patients had mild to moderate mitral valvular regurgitation, 4 had moderate mitral regurgitation and 2 had moderated to severe mitral and aortic regurgiation. The concomitant procedures included combined mitral and aortic replacements in 2 cases. Two patients died in hospital follow- up. Compared the parameters between pre-and post-operation, the left ventricular end systolic volume were 69±18 vs 42±16 ml, P〈0. 05, the left ventricular end diastolic volumes were 118±51 vs 79±25 ml, P〈0.05, LVEF was 0. 33± 0. 12% vs 0.40± 0. 14%.We also noted that 12 of 14 patients （86%） had significant improvement in the degree of mitral regurgitation based on echocardiography data after the card/opulmonary bypass and the other 2 cases underwent mitral annulus plasty, P〈0. 001, resulting in small regurgitaion finally. Conclusions The role of IOTEE i

关 键 词：术中经食管超声心动图 室壁瘤 左室 外科处理 

分 类 号：R654.2[医药卫生—外科学] R445.1[医药卫生—临床医学]