CAJ | 학술논문

目的：探讨经食管超声心动图（ TEE ）在直视微创二尖瓣外科手术中的应用价值。方法选择行心脏外科直视微创二尖瓣手术患者150例，男57例（38档．0％），女93例（62．0％），平均年龄（50．6±13．5）岁。术前超声诊断二尖瓣中重度返流116例，二尖瓣重度狭窄18例，二尖瓣返流合并狭窄14例，机械瓣瓣周漏2例。参照心外科Carpentier瓣膜分区法确定病变位置，制定手术方案，术中TEE监测下建立体外循环，右侧胸腔前外侧小切口，行直视下微创二尖瓣手术。心脏复跳后TEE监测心脏排气、测量瓣口相关参数评估手术疗效。结果术中TEE再次评价瓣膜病变后修改手术方案8例。二尖瓣成形术49例，二尖瓣人工瓣膜置换62例，二尖瓣置换＋三尖瓣人工瓣环成形术36例，二尖瓣置换＋冠状动脉搭桥1例，二尖瓣人工机械瓣周漏修补术2例。49例瓣膜成形术患者术前、术后二尖瓣返流面积分别为（11．19±5．31） cm2和（1．21±0．31） cm2（ t ＝18．213， P ＜0．05），返流束缩流颈宽度分别为（7．48±2．75）mm和（1．07±0．51）mm（ t ＝7．320， P ＜0．05），瓣口面积分别为（4．67±1．49） cm2和（3．58±1．13） cm2（ t ＝1．104， P ＞0．05），瓣口最大跨瓣压差分别为（3．07±1．11） mm Hg和（3．81±1．44）mm Hg（ t ＝-0．748， P ＞0．05）。二尖瓣成形术后TEE评价2例疗效不满意改为人工瓣膜置换术。62例人工瓣膜置换术后均无瓣周漏。结论 TEE在直视微创二尖瓣术前评价瓣膜情况、引导体外循环的建立、术后监测心内排气、评价手术疗效等方面具有引导和评估作用，为手术的成功提供重要保障。
목적：탐토경식관초성심동도（ TEE ）재직시미창이첨판외과수술중적응용개치。방법선택행심장외과직시미창이첨판수술환자150례，남57례（38당．0％），녀93례（62．0％），평균년령（50．6±13．5）세。술전초성진단이첨판중중도반류116례，이첨판중도협착18례，이첨판반류합병협착14례，궤계판판주루2례。삼조심외과Carpentier판막분구법학정병변위치，제정수술방안，술중TEE감측하건입체외순배，우측흉강전외측소절구，행직시하미창이첨판수술。심장복도후TEE감측심장배기、측량판구상관삼수평고수술료효。결과술중TEE재차평개판막병변후수개수술방안8례。이첨판성형술49례，이첨판인공판막치환62례，이첨판치환＋삼첨판인공판배성형술36례，이첨판치환＋관상동맥탑교1례，이첨판인공궤계판주루수보술2례。49례판막성형술환자술전、술후이첨판반류면적분별위（11．19±5．31） cm2화（1．21±0．31） cm2（ t ＝18．213， P ＜0．05），반류속축류경관도분별위（7．48±2．75）mm화（1．07±0．51）mm（ t ＝7．320， P ＜0．05），판구면적분별위（4．67±1．49） cm2화（3．58±1．13） cm2（ t ＝1．104， P ＞0．05），판구최대과판압차분별위（3．07±1．11） mm Hg화（3．81±1．44）mm Hg（ t ＝-0．748， P ＞0．05）。이첨판성형술후TEE평개2례료효불만의개위인공판막치환술。62례인공판막치환술후균무판주루。결론 TEE재직시미창이첨판술전평개판막정황、인도체외순배적건립、술후감측심내배기、평개수술료효등방면구유인도화평고작용，위수술적성공제공중요보장。
Objective To discuss the value of transesophageal echocardiography ( TEE ) in the minimally invasive mitral valve operation .Methods Totally 150 patients were performed minimally invasive mitral operation , 57 males and 93 female, mean age was (50.6 ±13.5) y.Severe mitral regurgitation were found in 116 patients, severe mitral stenosis were found in 18 patients, severe mitral regurgitation combined stenosis were found in 14 cases, 2 cases had mechanical prosthetic paravalvular leakage .Referring to Carpentier method to determine the lesion location , TEE was performed for venous cannula-tion guidance and building the extracorporeal circulation .Completing the mitral valvular operations by the right anterolateral minithoractomy through the 4th intercostals.Assess the effective deairing , cardiac function and the results of operation by the TEE at the time of weaning from cardiopulmonary bypass (CBP).Results Mitral valve repair (MVP) in 49, mitral valve re-place (MVR) in 98, MVR associated CABG in 1 case, repairing the perivalvular leakage in 2 cases (beating heart).In MVP 49 cases, mitral regurgitation area, vena contracta width, orifice area and maximum pressure grade across mitral orifice were (11.19 ±5.31)cm2 vs.(1.21 ±0.31)cm2( t =18.213, P <0.05), (7.48 ±2.75) mm vs.(1.07 ±0.51)mm ( t =7.320,P <0.05), (4.67 ±1.49) cm2 vs.(3.58 ±1.13)cm2( t =1.104,P >0.05), (3.07 ±1.11)mm Hg vs.(3.81 ± 1.44)mm Hg ( t =0.748, P >0.05) preoperative and postoperative respectively .Two cases of MVP were changed to MVR , because of unsatisfied efficacy evaluated by TEE .62 cases of MVR had no paravalvular leakage .Conclusion TEE is useful in guiding placement of the building of CPB , evaluating valve structure and the cardiac function and deairing detection during minimal invasive mitral valve operation .