经食管超声心动图在肥厚型梗阻性心肌病心肌切除术中的应用  

Application of intraoperative transesophageal echocardiography in myocardial myectomy for hypertrophic obstructive cardiomyopathy

作　　者：李馨[1] 贺声[1] 张云山[1] 刘秋颖[1] 沈燕华[1] 

机构地区：[1]海军总医院超声诊断科,北京市100048

出　　处：《临床超声医学杂志》2014年第8期552-554,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨多平面经食管超声心动图(TEE)在肥厚型梗阻性心肌病(HOCM)手术治疗中的应用价值。方法 16例行左室流出道疏通术的HOCM患者,TEE在建立体外循环前测量心肌厚度、左室流出道内径、左室流出道收缩期峰值压力阶差,估测室间隔切除的深度和长度,协助外科医师选择适宜的手术方式;心脏复跳之后即刻判定手术疗效和预后,指导外科医生适时关胸。结果与术前比较,HOCM患者左室流出道疏通术后室间隔厚度、左室流出道压力阶差均下降,而左室流出道内径增宽(均P<0.05)。术前9例二尖瓣轻-中度关闭不全,7例二尖瓣中度关闭不全;术后16例二尖瓣前叶前向运动全部消失,仅2例二尖瓣微量反流。术前10例主动脉瓣轻度关闭不全术后即刻消失。结论左室流出道疏通术中TEE能够修正完善术前诊断,提高手术疗效,减少手术并发症。Objective To explore the application value of multiplane transesophageal echoeardiography （TEE）in the operation for hypertrophic obstrucvie cardiomyopathy （HOCM）. Methods TEE was performed in16 patients with HOCM who would receive left ventricular septal myectomy. The width of LVOT,thickness of interventricular septum and left ventricular outflow tract pressure gradient were measured before the extracorporeal circulation was constructed,which helped surgeons to choose the operation way ,evaluate the curative effect and prognosis right after heart re-beat and guide surgeons to close the chest. Results Compared with preoperative measurement,the septal thickness and LVOT pressure gradient were significant decreased while the LVOT width were significant increased （P〈0.05）.There were 9 cases with mild to moderate mitral valve insufficiency and 7 cases with moderate mitral insufficiency preoperative. Mitral anterior motion disappeared in all 16 cases soon after operation and only trace mitral valve regurgitation occurred in 2 cases. Mild aortic valve insufficiency occurred in 10 cases before operation,but disappeared after operation. Conclusion TEE can correct and complete the preoperative diagnosis in left ventricular septal myectomy,which help improve the curative effect and reduce the operative complication.

关 键 词：超声心动描记术 经食管 肥厚型梗阻性心肌病 室间隔 左室流出道 

分 类 号：R542.2[医药卫生—心血管疾病] R540.45[医药卫生—内科学]