术中经食管超声心动图引导经胸微小切口封堵主动脉窦瘤破裂的临床应用  

Application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm by cardiac interventional therapy via mini-thoracotomy

作　　者：王小锋[1] 聂芳[1] 叶娜[1] 侯晓燕[1] 刘学会[1] 

机构地区：[1]兰州大学第二医院超声医学中心,730030

出　　处：《中华超声影像学杂志》2016年第2期122-125,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨术中经食管超声心动图（TEE）在引导经胸微小切口封堵主动脉窦瘤破裂（RASA）术中的应用价值。方法麻醉后对38例RASA患者进行详细的术前TEE检查，并与经胸超声心动图（TTE）检查结果进行对比，明确术前诊断并作定量评估，术中准确引导导丝及鞘管顺利进入窦瘤破口，评估封堵伞的位置、稳定性及对瓣膜的影响。结果38例患者经TEE检查筛选出可以进行介入封堵治疗的患者共20例。在TEE引导下成功封堵RASA患者16例，其中无冠窦瘤破入右心房8例，破入右心室5例，右冠窦瘤破入右室流出道3例。封堵成功患者各项生命体征平稳，心腔结构未发生明显改变，心功能正常。术后多次复查，所有患者封堵器位置正常，主动脉瓣启闭运动正常，未见狭窄及反流信号，也未检测到残余分流。结论进行TEE检查能有效地对主动脉窦瘤术前检查确诊，弥补和纠正其遗漏或错误，为术者提供直观的图像及有关的定量信息，引导术者准确放置封堵器，及时对手术效果进行准确评估。Objective To assess the application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm （RASA） by cardiac interventional therapy via mini thoracotomy. Methods After anesthesia transesophageal echocardiography （TEE） was performed in patients with RASA to confirm or correct primary diagnosis from transthoracic echocardiography（TTE） and to predict the operative effect. During the operation the guide wire and Sheath pipe were accurately guided into rupture mouth of aortic sinus aneurysm by TEE. After the operation, the position of closure and the function of aortic valve need to check carefully. Results Collection of 38 patients with aortic sinus aneurysm rupture, 20 patients who can be received interventional therapy were select by TEE. Sixteen patients accepted interventional treatment successfully, including 8 cases with non-coronary sinus tumor to break into the right atrium, 5 cases with non-coronary sinus tumor to break into the right ventricle, and 3 cases with right coronary sinus tumor to break into the right ventrieular outflow tract （3 cases）. The patients who received intervention treatment successfully had stable vital signs, and no obvious changes of heart cavity structure and cardiac function in normal. Postoperative multiple reexamination, all patients showed the normal closure position, aortic valve opening and closing movement. And no stenosis and reflux signal, no residual shunt was detected. Conclusions TEE can confirm or correct primary diagnosis of TTE before the operation and guide the surgery operator to place the closure correctly during the operation and evaluate the effect of the treatment after the operation.

关 键 词：超声心动描记术 经食管 主动脉窦瘤 动脉瘤 破裂 

分 类 号：R540.45[医药卫生—心血管疾病]