经胸及术中经食管超声心动图在主动脉夹层诊疗中的应用  

Transthoracic and intraoperative transesophageal echocardiography in diagnosis and assessment of aortic dissection

作　　者：王燕[1] 王浩[1] 朱振辉[1] 李永青[1] 逄坤静[1] 孟红[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院超声科,北京100037

出　　处：《中国医学影像技术》2013年第10期1621-1624,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨TTE及术中经食管超声心动图(IOTEE)在主动脉夹层(AD)术前诊断、术中监测及术后随访中的应用价值。方法收集经手术证实的56例AD患者的超声心动图资料,均于手术前后接受TTE和IOTEE检查。结果 56例AD中,DeBakeyⅠ型36例,Ⅱ型12例,Ⅲ型8例。TTE诊断AD敏感度为89.29%(50/56),IOTEE为100%(56/56);IOTEE诊断AD分型、假腔内血栓形成、内膜撕脱、破口位置优于TTE。IOTEE于术后即刻评价主动脉瓣功能,2例接受带瓣人工血管主动脉根部替换术者出现瓣周漏,再次修补后无明显瓣周漏,余瓣膜功能正常;术后3天至1个月TTE复查显示55例瓣膜及人工血管功能正常,1例左冠状动脉吻合口撕裂,再次行冠状动脉吻合术后恢复正常。结论 TTE在初步诊断AD及术后随访中具有重要作用;IOTEE对决定AD手术方案和即刻评价手术效果具有独特价值。Objective To explore the value of TTE and intraoperative transesophageal echocardiography （IOTEE） in preoperative diagnosis, intraoperative monitoring and postoperative follow-up of aortic dissection （AD）. Methods A total of 56 patients with AD underwent TTE and IOTEE before and after surgical operation. Results There were 36 cases of DeBakey I type AD, 12 of DeBakey Ⅱ type and 8 of DeBakey Ⅲ type AD.The diagnostic sensitivity of TTE was 89.29% （50/56）, while of IOTEE was 100% （56/56）. IOTEE was superior to TTE in typing AD and assessment of thrombosis in the false lumen, intimal tearing and location of the rupture. Paravalvular leaks were detected in 2 cases receiving Bentall procedures by IOTEE immediately after operation and were repaired again successfully. The function of aortic valves in the other cases were normal. Three days to 1 month after operation, TTE showed that the function of aortic valves and artificial vessels were normal in 55 cases and the anastomosis of left coronary was tore in 1 case which received anastomosis again and recovered. Conclusion TTE plays an important role in diagnosis and postoperative follow-up of AD, and IOTEE does an important job in selection of surgical method and assessment of operation effect immediately.

关 键 词：超声心动描记术 超声心动描记术 经食管 动脉瘤 夹层 

分 类 号：R540.45[医药卫生—心血管疾病] R543.1[医药卫生—内科学]