术中超声心动图在部分复杂先心病手术中的应用
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摘要
论文第二部分术中经食管超声心动图评价REV手术
目的:应用术中经食管超声心动图(IOTEE)评价REV手术。
方法:使用IOTEE对10例复杂先天性心脏病欲施行REV手术的患者进行研究。其中5例为TGA,2例为CTGA,6例为DORV,10例均合并心内分流,开胸或体外循环前通过IOTEE评价瓣膜功能,房室动脉连接以及心内分流等情况,最终确定施行REV手术的可行性。术毕心脏复跳后通过IOTEE即刻评价心内的结构和血流动力学变化状况。
结果:所有患者的心内分流均消失,无残余分流;所有患者均实现正常的房室及动脉连接关系;1例右室流出道血流速度偏快,压差约25mm Hg(1mmHg=0.133KPa),2例左室流出道流速偏快,压差约16mm Hg;2例出现右室功能不全,均行二次辅助转机和ECMO辅助。
结论:IOTEE能够即刻评价REV术的可行性和手术效果,是一种有效的评价复杂先心病的解剖和血流动力学的矫治变化的工具。
论文第三部分术中经食管超声心动图引导及监测大动脉根部双换位术
目的:应用术中经食管超声心动图引导及监测大动脉根部双换位术(改良的Nikaidoh手术)。
方法:使用IOTEE对17例复杂先天性心脏病欲施行改良的Nikaidoh手术的患者进行研究。其中10例为TGA,4例为CTGA,3例为DORV,17例均合并左室流出道狭窄,开胸或体外循环前通过IOTEE评价瓣膜功能,房室动脉连接,双流出道以及心内分流情况,最终确定施行改良的Nikaidoh手术的可行性。术毕心脏复跳后通过IOTEE即刻评价心内的结构和血流动力学变化状况。
结果:所有患者的心内分流均消失,无残余分流;所有患者均实现正常的房室及动脉连接关系;1例右室流出道血流速度偏快,压差约25mmHg,2例左室流出道流速偏快,压差均大于10mmHg;1例出现右室功能不全,行ECMO辅助。
结论:IOTEE能够引导及监测大动脉根部双换位术(改良的Nikaidoh手术),是一种有效的评价复杂先心病的解剖和血流动力学的矫治变化的工具。
Assessment of Lecompte Procedure (REV) by Intraoperative Transesophageal Echocardiography
Objective : To assess the REV procedure by using intraoperative transesophageal echocardiography.
Methods: Ten patients with complicated congenital heart diseases who were arranged for REV procedure were included in this study. Among them, 5 with transposition of the great arteries, 2 with corrected transposition of the great arteries, 6 with double outlet of the right ventricle,and all of them with the intracardiac shunt. IOTEE was preformed before cardiopulmonary bypass in the operating room. The function of the valves, the atrialventricular and ventriculoarterial connection and the intracardiac shunt were assessed by the IOTEE imaging, which helped the surgeons to determine the feasibility and probability of the REV procedure. The alterations of the morphology and hemodynamic informations were evaluated by IOTEE when the patients were off pump.
Results: All the intracardiac shunts were dissapeared, no residual shunt were detected .All the patients realize the normal connections of the artrium-ventricle and ventricle-arteries.One with identification of flow acceleration of the left ventricular outflow tract, of which the peak gradient is 25mmHg;The other two with identification of flow acceleration of the right ventricular outflow tract , the peak gradient is 16mmHg. Two had right ventricular dysfunction,which need the second cardiopulmonary bypass and extracorporeal membrane oxygenator (ECMO) treatment.
Conclusions: IOTEE provides a practial and valuable technique during REV procedure which can both evaluate and guide the operations of the complicated congenital heart diseases.
Guiding and Monitering modified Nikaidoh Procedure by Intraoperative transesophageal Echocardiography
Objective: To guide and moniter the modified Nikaidoh procedure by using intraoperative transesophageal echocardiography.
Methods: Seventeen patients with complicated congenital heart diseases who were arranged for modified Nikaidoh procedure were included in this study. Among them, 10 with transposition of the great arteries, 4with corrected transposition of the great arteries, 3 with double outlet of the right ventricle,and all of them with stenosis of the left ventricular outflow tracts .IOTEE was preformed before cardiopulmonary bypass in the operating room. The function of the valves, the atrialventricular and ventriculoarterial connection ,the biventricular outflow tracts and the intracardiac shunt were assessed by the IOTEE imaging, which helped the surgeons to determine the feasibility and probability of the modified Nikaidoh procedure. The alterations of the morphology and hemodynamic informations were evaluated by IOTEE when the patients were off pump.
Results: All the intracardiac shunts were dissapeared, no residual shunt were detected .All the patients realized the normal connections of the artrium-ventricle and ventricle-arteries. One with identification of flow acceleration of the left ventricular outflow tract ,of which the peak gradient was 25mmHg;The other two with identification of flow acceleration of the right ventricular outflow tract , the peak gradient were both over 10mmHg. One had right ventricular dysfunction,which need the extracorporeal membrane oxygenator (ECMO) treatment.
Conclusions: IOTEE provides a practial and valuable technique during modified Nikaidoh procedure ,which can both evaluate and guide the operations of the complicated congenital heart diseases.
目的:应用术中经食管超声心动图(IOTEE)评价REV手术。
方法:使用IOTEE对10例复杂先天性心脏病欲施行REV手术的患者进行研究。其中5例为TGA,2例为CTGA,6例为DORV,10例均合并心内分流,开胸或体外循环前通过IOTEE评价瓣膜功能,房室动脉连接以及心内分流等情况,最终确定施行REV手术的可行性。术毕心脏复跳后通过IOTEE即刻评价心内的结构和血流动力学变化状况。
结果:所有患者的心内分流均消失,无残余分流;所有患者均实现正常的房室及动脉连接关系;1例右室流出道血流速度偏快,压差约25mm Hg(1mmHg=0.133KPa),2例左室流出道流速偏快,压差约16mm Hg;2例出现右室功能不全,均行二次辅助转机和ECMO辅助。
结论:IOTEE能够即刻评价REV术的可行性和手术效果,是一种有效的评价复杂先心病的解剖和血流动力学的矫治变化的工具。
论文第三部分术中经食管超声心动图引导及监测大动脉根部双换位术
目的:应用术中经食管超声心动图引导及监测大动脉根部双换位术(改良的Nikaidoh手术)。
方法:使用IOTEE对17例复杂先天性心脏病欲施行改良的Nikaidoh手术的患者进行研究。其中10例为TGA,4例为CTGA,3例为DORV,17例均合并左室流出道狭窄,开胸或体外循环前通过IOTEE评价瓣膜功能,房室动脉连接,双流出道以及心内分流情况,最终确定施行改良的Nikaidoh手术的可行性。术毕心脏复跳后通过IOTEE即刻评价心内的结构和血流动力学变化状况。
结果:所有患者的心内分流均消失,无残余分流;所有患者均实现正常的房室及动脉连接关系;1例右室流出道血流速度偏快,压差约25mmHg,2例左室流出道流速偏快,压差均大于10mmHg;1例出现右室功能不全,行ECMO辅助。
结论:IOTEE能够引导及监测大动脉根部双换位术(改良的Nikaidoh手术),是一种有效的评价复杂先心病的解剖和血流动力学的矫治变化的工具。
Assessment of Lecompte Procedure (REV) by Intraoperative Transesophageal Echocardiography
Objective : To assess the REV procedure by using intraoperative transesophageal echocardiography.
Methods: Ten patients with complicated congenital heart diseases who were arranged for REV procedure were included in this study. Among them, 5 with transposition of the great arteries, 2 with corrected transposition of the great arteries, 6 with double outlet of the right ventricle,and all of them with the intracardiac shunt. IOTEE was preformed before cardiopulmonary bypass in the operating room. The function of the valves, the atrialventricular and ventriculoarterial connection and the intracardiac shunt were assessed by the IOTEE imaging, which helped the surgeons to determine the feasibility and probability of the REV procedure. The alterations of the morphology and hemodynamic informations were evaluated by IOTEE when the patients were off pump.
Results: All the intracardiac shunts were dissapeared, no residual shunt were detected .All the patients realize the normal connections of the artrium-ventricle and ventricle-arteries.One with identification of flow acceleration of the left ventricular outflow tract, of which the peak gradient is 25mmHg;The other two with identification of flow acceleration of the right ventricular outflow tract , the peak gradient is 16mmHg. Two had right ventricular dysfunction,which need the second cardiopulmonary bypass and extracorporeal membrane oxygenator (ECMO) treatment.
Conclusions: IOTEE provides a practial and valuable technique during REV procedure which can both evaluate and guide the operations of the complicated congenital heart diseases.
Guiding and Monitering modified Nikaidoh Procedure by Intraoperative transesophageal Echocardiography
Objective: To guide and moniter the modified Nikaidoh procedure by using intraoperative transesophageal echocardiography.
Methods: Seventeen patients with complicated congenital heart diseases who were arranged for modified Nikaidoh procedure were included in this study. Among them, 10 with transposition of the great arteries, 4with corrected transposition of the great arteries, 3 with double outlet of the right ventricle,and all of them with stenosis of the left ventricular outflow tracts .IOTEE was preformed before cardiopulmonary bypass in the operating room. The function of the valves, the atrialventricular and ventriculoarterial connection ,the biventricular outflow tracts and the intracardiac shunt were assessed by the IOTEE imaging, which helped the surgeons to determine the feasibility and probability of the modified Nikaidoh procedure. The alterations of the morphology and hemodynamic informations were evaluated by IOTEE when the patients were off pump.
Results: All the intracardiac shunts were dissapeared, no residual shunt were detected .All the patients realized the normal connections of the artrium-ventricle and ventricle-arteries. One with identification of flow acceleration of the left ventricular outflow tract ,of which the peak gradient was 25mmHg;The other two with identification of flow acceleration of the right ventricular outflow tract , the peak gradient were both over 10mmHg. One had right ventricular dysfunction,which need the extracorporeal membrane oxygenator (ECMO) treatment.
Conclusions: IOTEE provides a practial and valuable technique during modified Nikaidoh procedure ,which can both evaluate and guide the operations of the complicated congenital heart diseases.
引文
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2. Yang JF,Hu DX,Hu JG,et al. Sungical treatment of double outlet right ventricle.CMJ,2005,118:344-347.
3. Takeuchi K, McGowan FX,Moran AM, et al. Sungical outcome of double-outlet right ventricle with subpulmonary VSD. Ann Thorac Surg,2001,71(1):49-52.
4. Wetter J,Sinzobahamvya N,Blachczok HC,et al. Results of arterial switch operation for primary total correction of Taussing-Bing anomaly.Ann Thorac Surg,2004,77:41-46.
5. Marbero-Marcial M,Tanamati C, AtikeE', et al. Intraventricular repair of double-outlet right ventricle with noncommittod ventricular septal defect adventages of multiple patches.J Thorac Cardiovasc Surg,1999,118:1056-1057.
6. Lacour-Gayet F,Haun C,Ntalakoura K,et al. Biventricular repair of double-outlet right ventricle with non-committed ventriular septal defect (VSD) by VSD rerouting to pulmonary artery and arterial switch.Euro J Cardiothorac Surg,2002,21:1042-1048.
7. Hraska V,Duncan BW,Mayer JE,et al. Long-term outcome of surgically treated patients with corrected transposition of the great arteries.J Thorac Cardiovasc Surg,2005,129:182-191.
8. Yeh T, Connelly MS,Coles JG,et al. Atrioventricular discordance:results of repair in 127 patients.J Thorac Cardiovasc Surg, 1999,117:1190-1203.
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