CAJ | 학술논문

目的：总结分析经食管超声心动图在梗阻性肥厚型心肌病（HCM）扩大室间隔切除术中的应用价值。 　　方法：回顾性分析2012-01至2012-12因梗阻性HCM行扩大室间隔切除术56例患者术前经胸超声心动图，术中经食管超声心动图及术后经胸超声心动图结果。 　　结果：56例患者中男性36例，女性20例，年龄（46.1±11.3）13~67岁,术前室间隔厚度（26.1±6.9）15~46 mm，左心室流出道峰值压差（87.5±12.5）27~163 mmHg（1 mmHg=0.133 kPa），所有患者均成功完成外科手术，无住院死亡，无经食管超声心动图相关并发症，其室间隔切除厚度为（10.7±2.1）6~16 mm，长度为39.1±5.5（35~55）mm。与术前经胸超声心动图对比，经食管超声心动图显示术后即刻左心室流出道峰值流速[（1.68±0.46）m/s vs（4.57±0.99）m/s]、左心室流出道峰值压差[（11.3±7.0）mmHg vs（87.5±34.4）mmHg]均明显减低，二尖瓣反流及收缩期二尖瓣前向运动现象明显较少，差异均具有统计学意义（P均<0.001）。与术后经胸超声心动图结果对比，经食管超声心动图术后即刻左心室流出道峰值流速及峰值压差差异也具有统计学意义（P<0.001）,术中左心室流出道峰值流速（r=0.63）及左心室流出道峰值压差（r=0.48）与术后相关性良好。术后经食管超声心动图发现2例患者出现新发室间隔缺损，1例予以外科修补。 　　结论：经食管超声心动图可以安全用于HCM患者改良扩大室间隔切除术中监测，术前定性二尖瓣反流病因及程度，术后即刻评估左心室流出道梗阻缓解程度、二尖瓣反流程度并及时发现外科相关并发症以指导外科医生进行相应补救。
목적：총결분석경식관초성심동도재경조성비후형심기병（HCM）확대실간격절제술중적응용개치。 　　방법：회고성분석2012-01지2012-12인경조성HCM행확대실간격절제술56례환자술전경흉초성심동도，술중경식관초성심동도급술후경흉초성심동도결과。 　　결과：56례환자중남성36례，녀성20례，년령（46.1±11.3）13~67세,술전실간격후도（26.1±6.9）15~46 mm，좌심실류출도봉치압차（87.5±12.5）27~163 mmHg（1 mmHg=0.133 kPa），소유환자균성공완성외과수술，무주원사망，무경식관초성심동도상관병발증，기실간격절제후도위（10.7±2.1）6~16 mm，장도위39.1±5.5（35~55）mm。여술전경흉초성심동도대비，경식관초성심동도현시술후즉각좌심실류출도봉치류속[（1.68±0.46）m/s vs（4.57±0.99）m/s]、좌심실류출도봉치압차[（11.3±7.0）mmHg vs（87.5±34.4）mmHg]균명현감저，이첨판반류급수축기이첨판전향운동현상명현교소，차이균구유통계학의의（P균<0.001）。여술후경흉초성심동도결과대비，경식관초성심동도술후즉각좌심실류출도봉치류속급봉치압차차이야구유통계학의의（P<0.001）,술중좌심실류출도봉치류속（r=0.63）급좌심실류출도봉치압차（r=0.48）여술후상관성량호。술후경식관초성심동도발현2례환자출현신발실간격결손，1례여이외과수보。 　　결론：경식관초성심동도가이안전용우HCM환자개량확대실간격절제술중감측，술전정성이첨판반류병인급정도，술후즉각평고좌심실류출도경조완해정도、이첨판반류정도병급시발현외과상관병발증이지도외과의생진행상응보구。
Objective: To evaluate the intro-operative transesophageal echocardiography (TEE) for extended septal myectomy in patients with obstructive hypertrophic cardiomyophathy (HCM). Methods: A total of 56 obstructive HCM patients with extended septal myectomy in our hospital from 2012-01 to 2012-12 were retrospectively studied. The results of pre-operative transthoracic echocardiography, intro-operative TEE and post-operative transthoracic echocardiography were analyzed and compared. Results: There were 36 male and 20 female patients with the average age of (46.1 ± 11.3) years. The pre-operative width of inter ventricular septal was (26.1 ± 6.9) mm, left ventricular outlfow tract (LVOT) pressure gradient was (87.5 ± 12.5) mmHg. All patients received successful operation, no in-hospital death, no TEE related complication. The removed ventricular septal thickness was at (10.7 ± 2.1) mm, length at (39.1±5.5) mm. Compared with pre-operative transthoracic echocardiography, TEE indicated the immediate drop of post-operative LVOT peak velocity (4.57 ± 0.99)m/s vs (1.68±0.46)m/s and LVOT peak gradient (87.5 ± 34.4) vs (11.3 ± 7.0) mmHg, both P<0.001;signiifcant reduce of mitral regurgitation (MR) and mitral valve systotic onterior motion, both P<0.001. TEE showed that intra-operative LVOT peak velocity (r=0.63) and LVOT peak gradient (r=0.48) well related to post-operative transthoracic echocardiography. Post-operative TEE found that 2 patients had ventricular septal defect and 1 received surgical repair. Conclusion: TEE is safe for extended septal myectomy in obstructive HCM patients. It may pre-operatively identify the cause and degree of MR, evaluate the post-operative improvement of LVOT obstruction and MR. Meanwhile, TEE may ifnd the surgical complication for in time correction in relevant patients.