CAJ | 학술논문

目的探讨术中实时三维经食管超声心动图(RT 3D-TEE)在二尖瓣脱垂患者外科手术治疗中的应用价值.方法选择经胸超声心动图(2D-TTE)诊断为二尖瓣脱垂(伴或不伴腱索断裂),并进行外科手术治疗的35例患者,于麻醉后体外循环之前行RT 3D-TEE检查,将2D-TTE及RT 3D-TEE结果与术中所见进行比较.并在手术完成心脏复跳后即刻再次进行检查,评价手术疗效.结果与手术医师术中发现相比较,术中RT 3D-TEE判断脱垂瓣区的符合率为91.4％(32/35),而2D-TTE的符合率为82.9％(29/35),二者差异有统计学意义；对合并腱索断裂、赘生物形成及血栓形成诊断的灵敏性、特异性及Youden指数RT 3D-TEE均优于2D-TTE.28例行瓣膜成形术,7例行人工机械瓣置换术.3例患者因术中及时评估而避免二次手术.结论术中RT 3D-TEE可提供独特的“外科医生观”,全面显示瓣膜病变性质,对制定瓣膜手术方案具有重要参考价值.术中即刻评价自体成形瓣膜或人工瓣膜的功能,提高了手术的成功率.
목적 탐토술중실시삼유경식관초성심동도(RT 3D-TEE)재이첨판탈수환자외과수술치료중적응용개치.방법 선택경흉초성심동도(2D-TTE)진단위이첨판탈수(반혹불반건색단렬),병진행외과수술치료적35례환자,우마취후체외순배지전행RT 3D-TEE검사,장2D-TTE급RT 3D-TEE결과여술중소견진행비교.병재수술완성심장복도후즉각재차진행검사,평개수술료효.결과 여수술의사술중발현상비교,술중RT 3D-TEE판단탈수판구적부합솔위91.4％(32/35),이2D-TTE적부합솔위82.9％(29/35),이자차이유통계학의의；대합병건색단렬、췌생물형성급혈전형성진단적령민성、특이성급Youden지수RT 3D-TEE균우우2D-TTE.28례행판막성형술,7례행인공궤계판치환술.3례환자인술중급시평고이피면이차수술.결론 술중RT 3D-TEE가제공독특적“외과의생관”,전면현시판막병변성질,대제정판막수술방안구유중요삼고개치.술중즉각평개자체성형판막혹인공판막적공능,제고료수술적성공솔.
Objective To investigate the value of the intraoperative real-time three-dimensional transesophageal echocardiography (RT 3D-TEE) in therapeutic application of surgery for the mitral valve prolapse.Methods Thirty-five patients underwent surgical treatment were diagnosed as mitral valve prolapse by 2-dimensional transthoracic echocardiography (2D-TTE),with or without ruptured chordae tendineae.RT 3D-TEE was performed for assessing the segment of prolapse and its complications before cardiopulmonary bypass and after heart resuscitation respectively.The echocardiographic results were compared with the surgical findings.Results The accuracy of RT 3D-TEE to identify segments with prolapse was significantly higher than that of 2D-TTE (91.4％ vs 82.9％,P =0.003).RT 3D-TEE was more accurate than 2D-TTE for identifying ruptured chordae tendineae,vegetation and thrombus since higher sensitivity,specificity and Youden index.Among all 35 patients,valvuloplasty was performed in 28 cases,whereas,only 7 cases underwent replacement of prosthetic valves.Three patients were benefited by accurate evaluation of therapeutic effect using RT 3D-TEE in time.Conclusions Intraoperative RT 3D-TEE can be used to provide “ surgical view”,acquired adequate valuable information of mitral valve,and more reliable functional and anatomical assessment of the mitral valve components and its geometry.Suitable surgical intervention can be designed for improving outcomes of patients.