经食管超声心动图在左心室辅助装置植入术中的应用价值  

Role of transesophageal echocardiography in the intraoperative monitoring of left ventricular assist device implantation

作　　者：任书堂[1] 刘晓程[2] 王正清[2] 王试福 龙进[1] 黄云洲[1] 刘志刚[2] Ren Shutang;Liu Xiaocheng;Wang Zhengqing;Wang Shifu;Long Jin;Huang Yunzhou;Liu Zhigang(Department of Ultrasound,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiac Surgery,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiopulmonary Bypass,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院超声科,天津300457 [2]泰达国际心血管病医院心脏外科,天津300457 [3]泰达国际心血管病医院体外循环科,天津300457

出　　处：《中华超声影像学杂志》2022年第9期746-752,共7页Chinese Journal of Ultrasonography

基　　金：天津市自然科学基金重点项目(18JCZDJC36200);国家重点研发计划课题(2017YFC0111005);天津市医学重点学科外科学(心血管外科学)建设项目(TJYX2DXK-019A)。

摘　　要：目的探讨术中经食管超声心动图(TEE)在左室辅助装置(LVAD)植入术中的应用价值。方法选取2019年3月至2021年11月泰达国际心血管病医院在TEE监测下接受第三代LVAD—HeartCon血泵植入手术的23例重度心力衰竭患者,病因包括扩张型心肌病21例、心肌致密化不全1例和缺血性心肌病1例。患者均在体外循环转机前和停机后行TEE检查,监测左右心腔大小、左右心内径比值、心功能、排气、瓣膜反流、室间隔位置、套管位置、设备功能等。对LVAD植入前后左右心参数测值进行统计学分析。结果23例患者LVAD植入前左心明显增大,右心不同程度增大。二尖瓣反流中量以上者16例,中量以下者7例。主动脉瓣反流微少量13例。三尖瓣反流中量以上4例,中量以下16例。合并左心耳血栓2例。TEE显示,与术前相比,装置植入后左室内径明显减小(42.0 mm/m^(2)比32.8 mm/m^(2)),左室射血分数增高(22.2%比34.0%),差异有统计学意义(均P<0.05)。右室径值及面积变化率在LVAD植入前后差异无统计学意义(均P>0.05)。左室/右室内径比值较术前减低(2.09比1.69),差异有统计学意义(P<0.05)。室间隔由术前的向右偏移恢复至中线位置。LVAD植入后二尖瓣反流程度均不同程度减轻。全部患者均接受三尖瓣成形术,术后残余少量反流8例。结论HeartCon血泵可以充分有效地卸除左心室负荷,并为心力衰竭患者提供足够的心排出量。TEE对于LVAD植入术中决策有重要价值,可评价LVAD植入前的心脏病变、术中气栓、流入管位置、流出管通畅性和心功能,尤其是容量及左右心室平衡的评估,对于优化血泵功能至关重要。Objective To evaluate the clinical value of intraoperative transesophageal echocardiography(TEE)in monitoring left ventricular assist device(LVAD)implantation.Methods Between March 2019 and November 2021,23 consecutive patients from TEDA International Cardiovascular Hospital,including 21 cases with dilated cardiomyopathy,1 case with myocardial noncompaction and 1 case with ischemic cardiomyopathy,underwent HeartCon blood pump,a type of third generation LVAD implantation for severe heart failure.TEE was preformed in all cases before and after cardiopulmonary bypass.The dimensions of left-sided and right-sided cardiac chamber,ventricular function,de-airing,interventricular septal position,inlet cannulae position and the function of device were observed and recorded during LVAD implantation.Paired t test was used for statistical analysis of left-sided and right-sided heart parameters in pre-and post-operative measurements.Results The left heart was dilated significantly and coexistent with right heart enlargement in some degree before LVAD implantation in total 23 cases.More than moderate mitral regurgitation(MR)in 16 cases and less than moderate MR in 7 cases were present.Mild or trace aortic regurgitation(AR)existed in 13 cases.More than moderate tricuspid regurgitation(TR)in 4 cases and less than moderate TR in 16 cases were observed.Left atrial appendage thrombosis was detected in 2 cases.After LVAD implantation,TEE revealed that the left ventricular end-diastolic diameter reduced significantly(42 mm/m^(2) vs 32.8 mm/m^(2),P<0.05)and left ventricular ejection fraction increased accordingly(22.2%vs 34.0%,P<0.05).There were no significant differences in right ventricular diameter and fractional area change between pre-and post-operative findings(all P>0.05).The ratio of left ventricular inner diameter to right ventricular inner diameter(2.09 vs 1.69,P<0.05)decreased in total 23 cases after LVAD implantation.Interventricular septal position became neutral position instead of pre-oprative rightward position.The seve

关 键 词：超声心动描记术 经食管 左室辅助装置 HeartCon血泵 

分 类 号：R540.45[医药卫生—心血管疾病] R541.6[医药卫生—内科学]