围术期实时三维经食管超声心动图在微创二尖瓣修复术中的应用价值  

The Value of Perioperative Real-Time 3D Transesophageal Echocardiography in Minimally Invasive Mitral Valve Repair

作　　者：李建华[1] 王庆慧[1] 丁云川[1] 陈剑[1] 罗庆祎[1] 苏璇[1] 张瑜[1] Li Jianhua;Wang Qinghui;Ding Yunchuan;Chen Jian;Luo Qingyi;Su Xuan;Zhang Yu(Department of Ultrasound Medicine,The Affiliated Yan'an Hospital of Kunming Medical University,Kunming,Yunnan 650051,China)

机构地区：[1]昆明医科大学附属延安医院超声医学科,昆明市650051

出　　处：《中国超声医学杂志》2022年第11期1225-1228,共4页Chinese Journal of Ultrasound in Medicine

基　　金：云南省科技厅-昆明医科大学联合专项基金资助项目[No.2019FE001(-266)];云南省卫生科技计划项目(No.2016NS318)。

摘　　要：目的 探讨围术期应用实时三维经食管超声心动图在微创二尖瓣修复术的价值。方法 对35例二尖瓣退行性病变患者的微创二尖瓣修复术前和术后即刻进行实时三维经食管超声心动图(TEE)检查,使用二尖瓣定量分析软件(MVN)对采集的三维图像数据进行定量分析,对比二尖瓣相关定量参数术前术后的变化情况。术前在TEE监测下建立外周体外循环,术后指导心腔排气。结果 2例患者术前TEE纠正脱垂小叶定位及范围、2例患者补充腱索断裂的诊断;二尖瓣修复术后反流程度均为轻度,前向血流无梗阻;瓣环横径、前后径、瓣环面积、瓣环周长、前叶面积、后叶面积、瓣叶非平面夹角、主动脉-二尖瓣夹角较术前明显减小(P<0.05);前叶角度、后叶角度及对合高度较术前明显增大(P<0.05);平均跨瓣压差与术前比较无明显差异(P>0.05)。结论 实时三维经食管超声心动图能够在微创二尖瓣修复手术围术期定量分析二尖瓣病变、准确指导手术决策、评估手术效果,具有重要的应用价值。Objective To evaluate the value of real-time three-dimensional(3 D) transesophageal echocardiography(TEE) during minimally invasive mitral valve repair. Methods 3 D-TEE was performed in 35 patients with mitral valve degeneration before and immediately after minimally invasive mitral valve repair. To compare the changes in parameters of the mitral valve before and after surgery, a quantitative analysis with 3 D image data was performed using quantitative analysis software MVN. TEE was performed to monitor the procedures of extracorporeal circulation preoperatively, and to guide de-airing postoperatively. Results By 3 D TEE, the localization and extent of scallop prolapse were corrected preoperatively in two patients, and diagnosis of tendon ruptures were supplemented in two patients. Mild regurgitation was observed after mitral valve repair, and there was no obstruction in forwarding blood flow. Annulus anterolateral posteromedial(annulusALPM), annulus anteroposterior(annulus AP), annulus area, annulus circumference(annulus circ), anterior mitral leaflet area(AML area), posterior mitral leaflet area(PML area), Non-planar angle, and aorta-mitral angle were significantly decreased compared with the preoperative values(P<0.05). A significant increase in anterior leaflet angle(AL angle), posterior leaflet angle(PL angle), and coaptation depth was observed after the operation(P<0.05). There was no significant difference between mean pressure gradient and the preoperative value(P>0.05). Conclusions Three-dimensional transesophageal echocardiography can be used in minimally invasive mitral valve repair perioperatively as a tool in real-time for the mitral valve lesion quantification, surgery guiding and evaluation, and has an important value in clinical application.

关 键 词：经食管超声心动图 三维 二尖瓣修复术 围术期 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]