Echocardiography-assisted surgery in transaortic endovascular stent grafting: role of transesophageal echocardiography.
Echocardiography-assisted surgery in transaortic endovascular stent grafting: role of transesophageal echocardiography.
复制标题
超声心动图辅助手术在经主动脉血管内支架移植术中的作用：经食管超声心动图的作用。
DOI：
10.1067/mtc.2000.109237
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
O. Ishii
中科院分区：
文献类型：
--
作者：
K. Orihashi;Yuichiro Matsuura;Taijiro Sueda;M. Watari;K. Okada;Y. Sugawara;O. Ishii
目的
经食管超声心动图用于在动脉瘤和远端弓夹层的经主动脉支架植入术期间可视化血管内手术，并评价经食管超声心动图的使用。
方法
对16例连续患者（13例动脉瘤和3例夹层）进行了检查。经食管超声心动图用于（1）确定移植物尺寸，（2）引导将导管放置在降主动脉的适当位置，而不损伤内膜，（3）引导使用球囊导管进行移植物剪裁，以及（4）检查术后结果。
结果
1例曾接受过手术的患者出现可视化障碍。移植物尺寸是合适的，除了一名患者由于低估而导致的情况。经食管超声心动图有助于导航移植物放置和剪裁，而不会损伤内膜。我们试图与隔膜保持9 cm的距离，并保持4 cm的附件部分。在1例患者中，移植物放置得太远（距离隔膜7 cm），无法用移植物覆盖厚的动脉粥样硬化斑块。患者出现截瘫。经食管超声心动图对内漏和血栓排除的评估与术后计算机断层扫描或血管造影相同，灵敏度为100%（1/1），特异性为100%（13/13）。3例患者发现近端缝线泄漏和移植物扭结。通过经食管超声心动图评估（13例患者）成功进行血栓排除可预测中期随访期间动脉瘤和夹层的后续消退：分别有5例和8例患者完全消退和部分消退。
结论
经食管超声心动图可实现超声心动图辅助手术，并可进行安全的逐步腔内手术和即时术中评估，可预测术后结果。
OBJECTIVE
Transesophageal echocardiography was applied to visualizing endovascular procedures during transaortic stent grafting for aneurysm and dissection at the distal arch, and the use of transesophageal echocardiography was evaluated.
METHODS
The 16 consecutive patients (13 with aneurysms and 3 with dissections) were examined. Transesophageal echocardiography was used for (1) determining graft size, (2) guiding placement of the catheter in the descending aorta at an appropriate position without intimal damage, (3) guiding graft tailoring with a balloon catheter, and (4) examining the results after the procedures.
RESULTS
Visualization was disturbed in one patient who had undergone a previous operation. The graft size was appropriate, except in one patient as a result of underestimation. Transesophageal echocardiography was helpful for navigating the graft placement and tailoring without intimal damage. We tried to keep a distance from the diaphragm of 9 cm and an attachment portion of 4 cm. In one patient the graft was placed too distally (7 cm from the diaphragm) to cover the thick atheromatous plaque with the graft. The patient had paraplegia. Transesophageal echocardiographic assessment of endoleak and thromboexclusion was identical to that of postoperative computed tomography or angiography, with a sensitivity of 100% (1/1) and a specificity of 100% (13/13). Leakage at the proximal suture and graft kinking were found in 3 patients. Successful thromboexclusion by transesophageal echocardiographic assessment (13 patients) was predictive of subsequent regression of aneurysm and dissection in the midterm follow-up period: there was complete and partial regression in 5 and 8 patients, respectively.
CONCLUSION
Transesophageal echocardiography enables echocardiography-assisted operations with secure step-by-step endoluminal procedures and immediate intraoperative assessment, which is predictive of the postoperative results.