食管超声心动图在人工腱索二尖瓣成形术的应用  

Application of Transesophageal Echocardiography in mitral valve repair with artificial chordae

作　　者：杨智利[1] 陈莉[1] 胡杨柳[2] 赵景[1] 周翠翠[1] 

机构地区：[1]南昌大学第一附属医院超声科,江西南昌330006 [2]江西护理职业技术学院,江西南昌330029

出　　处：《中国现代医学杂志》2014年第33期98-101,共4页China Journal of Modern Medicine

摘　　要：目的探讨食管超声心动图（TEE）在人工腱索植入二尖瓣成形术中的应用价值。方法对32例行人工腱索植入二尖瓣成形术的二尖瓣脱垂患者,术前TEE观察二尖瓣脱垂部位并测量人工腱索参考长度,与术中所见为标准进行对比。术后TEE观察二尖瓣反流程度并测量前后瓣对合缘的高度实时监测评价手术效果。结果①32例患者术前TEE诊断34个瓣叶43个分区出现脱垂,术中发现35个瓣叶47个分区出现脱垂,TEE诊断准确率分别为97.14%和91.49%。②实际植入人工腱索长度较术前TEE测量短,偏差范围0.1～2.7 mm,平均偏差（1.24±0.64）mm,但所有患者术后效果良好,瓣膜启闭可。③32例患者中,术前有中度反流患者6例,重度反流患者26例;术后有轻微反流患者28例,轻度反流患者4例,二尖瓣反流情况较术前明显好转;前后瓣对合缘的高度均〉8 mm,平均为（10.30±0.43）mm,瓣膜对合情况良好。结论 TEE在人工腱索植入二尖瓣成形术中对判断二尖瓣脱垂部位、人工腱索的参考长度以及评价手术效果有重要帮助。[ Objective ] To investigate the value of transesophageal echocardiography in mitral valve repair with artificial chordae. [ Methods ] 32 patients with mitral valve prolapse underwent mitral valve repair using artificial chordae tendineae replacement. Preoperative transesophageal echocardiography was performed in all patients to lo- cate segments and leafs of prolapsed mitral valve and to measure the length of the normal chordae tendineae as the approximate length of the artificial chordae, the results compared to the surgical results which was considered as a standard. Postoperative transesophageal echocardiography was performed to determine the severity of mitral regurgita- tion （MR） and to measure the zone of coaptation, in order to monitor and evaluate the operation effect. [Results] A- mong the 32 cases with mitral valvular prolaps, 34 prolapsed valve leafs related to 43 segments were found by traMs- esophageal echocardiography. 35 prolapsed valve leafs related to 47 segments were confirmed by surgical result. The ratio of diagnosis was 97.14% and 91.49% respectively. The length of actual artificial chordae tendineae was shorter than the length of Preoperative TEE measurement, deviation range was 0.1-2.7 mm, the average deviation was （1.24＋ 0.64）mm, all Postoperative patients with good effect. Postoperative diagnosis included 28 mild regurgitation cases and 4 moderate regurgitation, compared preoperative diagnosis included moderate to severe regurgitation 6 cases and se- vere regurgitation 26 cases. The average Postoperative measurement of the zone of coaptation was （10.30±0.43）mm. [ Conclusions] TEE is helpful in mitral valve repair with artificial chordae for locating segments and leafs of pro- lapsed mitral valve, measuring the approximate length of the artificial chordae, evaluating the operation effect.

关 键 词：超声心动描记术 食管超声心动图 二尖瓣成形术 腱索 

分 类 号：R445.1[医药卫生—影像医学与核医学] R654.2[医药卫生—诊断学]