Utility of intraoperative transesophageal echocardiography for diagnosis of pulmonary embolism
Utility of intraoperative transesophageal echocardiography for diagnosis of pulmonary embolism
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DOI：
10.1213/01.ane.0000117284.25696.64
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发表时间：
2004-07-01
影响因子：
5.7
通讯作者：
Eltzschig, HK
中科院分区：
文献类型：
--
作者：
Rosenberger, P;Shernan, SK;Eltzschig, HK
肺栓塞（PE）与围手术期显著的发病率和死亡率相关。经食管超声心动图（TEE）可以直接显示肺动脉（PE）或肺动脉（PA）阻塞的继发征象。然而，其在术中PE诊断中的应用尚未明确。因此，我们对46例患者在肺栓塞切除术前进行术中TEE检查。复查TEE检查是否有右、左、主心室血栓栓塞的征象，以及急性心室梗阻的继发征象（右室功能障碍、中重度三尖瓣反流、房间隔向左弯曲）。血栓栓塞的确切位置是根据手术记录确定的。超声心动图显示PE存在的证据在46%的患者中得到了正确的证实（n = 21 / 46）。然而，在任何特定位置直接可视化血栓栓子的敏感性仅为26%。TEE对左PA血栓栓塞最不敏感（17%）。TEE证据显示96%的患者有右室功能障碍，50%的患者有三尖瓣反流，98%的患者有左房间隔弯曲。因此，术中TEE通过直接可视化诊断急性PE的应用是有限的。肺动脉梗阻的间接TEE证据可能有助于PE的诊断。
Pulmonary embolism (PE) is associated with significant perioperative morbidity and mortality. Transesophageal echocardiography (TEE) may permit direct visualization of PE or secondary signs of pulmonary artery (PA) obstruction. However, its utility in diagnosing PE in the intraoperative setting has yet to be defined. Therefore, we performed intraoperative TEE examinations in 46 patients immediately before pulmonary embolectomy. TEE examinations were reviewed for signs of thromboemboli within the right, left, and main PA, and secondary signs of acute PA obstruction (right ventricular dysfunction, moderate-to-severe tricuspid regurgitation, leftward bowing of the interatrial septum). The definitive location of thromboemboli was determined from the surgical record. Echocardiographic evidence for the presence of PE was correctly demonstrated in 46% of all patients (n = 21 of 46). However, the sensitivity for direct visualization of thromboemboli at any specific location was only 26%. TEE was least sensitive for thromboemboli it t the left PA (17%). TEE evidence of right ventricular dysfunction was observed in 96%, tricuspid regurgitation in 50%, and leftward interatrial septal bowing in 98% of examinations. Therefore, the use of intraoperative TEE to diagnose acute PE via direct visualization is limited. Indirect TEE evidence of PA obstruction may be helpful in supporting a diagnosis of PE.