Discrepancy between intraoperative transesophageal echocardiography and postoperative transthoracic echocardiography in assessing congenital valve surgery
Discrepancy between intraoperative transesophageal echocardiography and postoperative transthoracic echocardiography in assessing congenital valve surgery
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DOI：
10.1016/j.athoracsur.2006.06.073
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发表时间：
2006-12-01
影响因子：
4.6
通讯作者：
Sano, Shunji
中科院分区：
文献类型：
--
作者：
Honjo, Osami;Kotani, Yasuhiro;Sano, Shunji
背景。本研究的目的是探讨术中经食管超声心动图和术后经胸超声心动图在评估接受瓣膜修复的儿童残余反流方面的差异。方法。对 2001 年至 2004 年连续 42 名因瓣膜反流接受瓣膜修复术的儿童（中位年龄 5.1 岁）进行回顾性分析。将患者分为两组：房室瓣组（n = 33）和主动脉瓣组（n = 9）。将术中经食管超声心动图获得的反流等级、缩短分数和房室流入速度与出院时（中位，11 天）和随访时（中位，8 个月）经胸超声心动图获得的结果进行比较。结果。术中经食管超声心动图显示4例患者存在特定残留病灶，并成功再次修复。术中经食管超声心动图获得的缩短分数低于出院前经胸超声心动图获得的缩短分数（p < 0.01）。在房室瓣组中，术中经食管超声心动图获得的反流等级低于出院前经胸超声心动图获得的返流等级（0.7+/-0.8 vs 1.4+/-0.9；p<0.01），并且有12名患者（38%）发现两种检查之间一致。术中经食管超声心动图获得的峰值房室流入速度低于出院前经胸超声心动图获得的峰值房室流入速度（p < 0.01）。在主动脉瓣组中，两次检查的反流等级没有显着差异（0.8+/-0.8与1.1+/-0.9），9例患者中有5例（56%）反流等级完全一致。结论。这些检查对残余房室瓣反流和潜在房室瓣狭窄的评估存在相当大的差异：术中经食管超声心动图低估了大多数残余反流。相比之下，两种检查在评估主动脉瓣关闭不全方面的结果相当一致。
Background. The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair.Methods. Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months).Results. Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 +/- 0.8 versus 1.4 +/- 0.9; p < 0.01), and agreement between the two examinations was found in 12 patients (38%). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 +/- 0.8 versus 1.1 +/- 0.9), and complete agreement in regurgitation grade was found in 5 (56%) of 9 patients.Conclusions. There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.