The utility of transesophageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery.
The utility of transesophageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery.
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经食管超声心动图和多普勒彩色血流成像在接受心脏瓣膜手术的患者中的应用。
DOI：
10.1016/s0735-1097(10)80064-6
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发表时间：
1990
影响因子：
24
通讯作者：
Kisslo,J
中科院分区：
文献类型：
--
作者：
Sheikh,KH;deBruijn,NP;Rankin,JS;Clements,FM;Stanley,T;Wolfe,WG;Kisslo,J
为了评估术中经食管超声心动图在心脏瓣膜手术中的价值，我们对154例连续接受瓣膜手术并合并体外循环前后经食管造影的患者进行了研究。在154例患者中，有29例（19%）患者的预分流成像结果出乎意料地辅助或改变了计划手术。在154例患者中，有10例（6%）在搭桥后立即成像显示手术结果不理想，需要立即进一步手术。旁路手术后左心室功能不全，促使13例（8%）患者服用肌力药物。经食管超声心动图证实，在二尖瓣手术患者中，二维和多普勒彩色血流成像是最有用的，64例患者中有26例（41%）根据超声心动图结果做出手术决定。旁路手术后超声心动图结果确定患者有术后不良预后的风险。123例旁路手术后瓣膜功能满意的患者中，18例（15%）出现术后严重并发症，6例（5%）死亡；7例中度瓣膜残留功能不全患者中，6例（86%）出现术后并发症，3例（43%）死亡（p < 0.05）。同样，在131例旁路手术后左心室功能保留的患者中，12例（9%）有主要并发症，7例（5%）死亡，而在23例心室功能降低的患者中，17例（73%）有术后并发症，6例（26%）死亡（两者均p < 0.05）。这些数据表明，术中经食管超声心动图有助于制定手术计划，评估即时手术效果，识别结果不满意的患者，这些患者术后并发症的风险增加。
To assess the value of intraoperative transesophageal echocardiography during cardiac valve surgery, 154 consecutive patients who had a valve operation in conjunction with preand postcardiopulmonary bypass transesophageal imaging were studied. Prebypass imaging yielded unsuspected findings that either assisted or changed the planned operation in 29 (19%) of the 154 patients. Imaging immediately after bypass revealed unsatisfactory operative results that necessitated immediate further surgery in 10 (6%) of the 154 patients. Postbypass left ventricular dysfunction, prompting administration of inotropic agents, was identified in 13 patients (8%). Transesophageal echocardiography proved most useful when both two-dimensional and Doppler color flow imaging were employed in patients undergoing a mitral valve operation, where surgical decisions based on echocardiographic results were made in 26 (41%) of 64 cases.Postbypass echocardiographic findings identified patients at risk for an adverse postoperative outcome. Of 123 patients whose postbypass valve function was judged to be satisfactory, 18 (15%) had a major postoperative complication and 6 (5%) died, whereas of 7 patients with moderate residual valve dysfunction, 6 (86%) had a postoperative complication and 3 (43%) died (p < 0.05 for both). Likewise, of 131 patients with preserved postbypass left ventricular function, 12 (9%) had a major complication and 7 (5%) died, whereas of 23 patients with reduced ventricular function, 17 (73%) had a postoperative complication and 6 (26%) died (p < 0.05 for both).These data indicate that intraoperative transesophageal echocardiography is useful in formulating the surgical plan, assessing immediate operative results and identifying patients with unsatisfactory results who are at increased risk for postoperative complications.