心内超声技术在心脏介入诊疗中的应用进展

<正>心血管超声技术在心脏介入诊疗中起到非常重要的作用。传统的超声心动图包括经胸超声心动图(transthoracic echocardiography, TTE)和经食管超声心动图(transesophageal echocardiography, TEE)。TTE是临床工作中最常用的方法,但是容易受到含气的肺组织等其他心脏周围结构的影响,故TTE不能清晰显示远离探头的心房结构和近端心尖部结构。TEE可从食管显示心腔结构,特别是左心耳和瓣膜结构,但是仍有部分患者不能耐受TEE检查,以及存在麻醉和潜在的食管损伤/穿孔的风险。心内超声(intracardiac echocardiography,ICE)是将超声探头经外周静脉入径送至心腔内,由于ICE探头周围为心腔内血液,故能提供更加清晰的图像质量,且不受心     

卵圆孔未闭右心声学造影中国专家共识

临床上对卵圆孔未闭的生理及病理意义的认识日益深入,卵圆孔未闭是不明原因脑卒中、偏头痛、矛盾性栓塞等的病因之一。经食道超声心动图结合右心声学造影及充分的激发试验是诊断卵圆孔未闭的金标准成像方式,但是该操作流程及诊断标准国内尚无统一标准。因此,经食道超声心动图临床应用的中国专家共识专家组参考国内外相关研究、专家共识以及指南,共同制订此专家共识,以指导临床实践。     

经食道超声心动图临床应用价值分析

经食道超声心动图(TEE),是经胸超声心动图(TTE)的必要补充。我科自2001年12月开展经TEE检查以来,共完成66例70人次的检查,取得较为满意的效果,现将初步应用报道如下。1资料和方法1·1一般资料:66例均为我院2001年12月至2005年12月住院或门诊病人,男性39例,女性27例,年龄14-74岁,平均47.2岁,所有病例经胸超声心动图均未能明确诊断而要求经食道超声心动图检查,检查前均无明显出血倾向及食道梗阻症状和乙肝病史。1·2方法:使用CE-VIVIDfive彩色多普勒超声诊断仪,配有全平面成人经食道超声探头,频率5.0-7.5MHz。患者左侧卧位,检查前连接…     

卵圆孔未闭超声诊断中国专家共识

随着对卵圆孔未闭（PFO）相关疾病认识的深入及经导管封堵术等治疗的广泛开展，PFO的精准诊断和评估（包括有无PFO、分流量、相关解剖）成为临床迫切需求。《卵圆孔未闭超声诊断中国专家共识》专家组参考国内外相关研究、共识及指南，达成超声技术（包括经胸/经食管超声心动图联合右心声学造影、对比增强经颅多普勒超声、心腔内超声）诊断PFO的临床应用专家共识，以指导临床实践。     

实时经食道三维超声心动图在结构性心脏病中的应用及研究前景

实时经食道三维超声心动图(3D TEE)是超声成像领域内的一项重大技术性突破。与实时经胸三维超声心动图相比,3D TEE具有图像更加清晰、探头不干扰手术视野等优越性。除了技术和方法的提高,3D TEE将来更多的研究可能在于其教学价值和对外科手术决策的影响。本综述主要阐述了3D TEE在结构性心脏病诊断中的应用。     

经胸与经食管超声心动图对先天性二叶式主动脉瓣诊断的比较

目的　比较经胸超声心动图 (TTE)与经食管超声心动图 (TEE)对先天性二叶式主动脉瓣畸形诊断的准确率。方法　应用TTE及TEE检查明确诊断先天性二叶式主动脉瓣畸形及其他主动脉瓣病变。结果　 10 7例患者主动脉瓣听诊区可闻及Ⅱ～Ⅲ级收缩期及舒张期杂音 ,经TTE检查 ,仅有 5 1例患者可明确诊断 ,而用TEE检查均可明确诊断。结论　TEE可进一步明确诊断患者主动脉瓣病变为先天性与获得性 ,有利于临床诊断及治疗。     

经胸与经食管超声心动图对先天性与获得性主动脉瓣病变诊断的比较

目的比较经胸超声心动图(TTE)与经食管超声心动图(TEE)对先天性与获得性主动脉瓣病变诊断的准确率.方法应用TTE与TEE检查,诊断先天性与获得性主动脉瓣病变及并发症.结果107例患者主动脉瓣听诊区可闻及Ⅱ～Ⅲ级收缩期及舒张期杂音,TTE检查不能明确诊断.而TEE检查均可明确诊断.结论TEE检查可进一步明确诊断先天性与获得性心脏病,有利于临床诊断及治疗.     

经食道超声心动图检查的危险性

对不同的心脏疾患和胸主动脉病变,经食道超声心动图(TEE)检查的诊断价值已有报告,而 TEE 的危险性和潜在并发症报告还甚少.本文对不同心脏病患者 TEE 检查的危险性进行研究.方法:54例(男29,女25),年龄19—79岁(平均54±15岁),均患有不同的心脏病(如主动脉瓣病变,二尖瓣病变,感染性心内膜炎,胸主动脉瘤等)。检查前禁食至少4小时,局部喷洒麻醉后,经口插入探头。仪器:Varian 3400R 型超声心动图机,探头3.5mHz.用 Cardiodata MK4型作24小时 Holter 监护,24小时 Holter 监护减去TEE 时间为对照期,TEE 过程仍持续 Holter 监护.TEE 时间为探头插入至经口腔取出时间,对照和 TEE 时均用自动血压检测器记录 BP,HR.     

成人房间隔缺损经导管Amplatzer闭合治疗经食管超声检测价值

本文介绍经食道超声 ( TEE)监测下成人房间隔缺损( ASD)经导管 Amplatzer闭合术的体会。1　资料与方法1.1　研究对象经胸壁超声心动图 ( TTE)和 TEE检查确诊的先天性心脏病继发孔中央型 ASD 11例 ,男 3例 ,女 8例 ,年龄 2 1～ 40( 3 5± 8)岁。肺动脉收缩压 2 7.9± 7.7m m Hg。均为单一缺口。1.2　仪器应用 HPSONOS新 10 0 0型彩色多普勒超声诊断仪 ,经胸壁探头频率 2 .5 MHz,TEE探头频率 5 .0 MHz。1.3　检查和监测方法常规进行 TTE检查筛选病人 ,然后行 TEE检查 ,分别在水平扫描四腔心切面和纵切扫描二房和上下腔静脉切面…     

经食管超声心动图在房颤介入治疗前左心耳血栓检查中的应用价值

目的探讨经食管超声心动图（TEE）在房颤介入治疗前左心耳血栓检查中的应用价值。方法对48例拟行射频消融、经皮穿刺二尖瓣球囊成形术（PBMV）的房颤患者应用经胸超声心动图（TTE）筛查,对未发现左房血栓或可疑左心耳血栓者进一步行TEE检查,以确定左心耳有无血栓。结果 48例房颤患者常规TTE检查42例未发现左心耳血栓,2例可疑左心耳血栓。TEE检查在48例中发现9例左心耳血栓,占18.7%（7/48）,发现左心耳＂自发性显影＂8例。结论 TEE在房颤介入治疗前左心耳血栓检查中具有重要的临床应用价值。     

Reprocessing of flexible endoscopes and endoscopic accessories - an international comparison of guidelines

Endoscopic examinations and procedures are essential for diagnosis and treatment of gastrointestinal diseases. As a result of poor reprocessing practice microorganisms can be transmitted via endoscope. The majority of infection transmissions is due to insufficient performance of cleaning and disinfection disregarding guidelines of societies of gastrointestinal endoscopy. A review of the literature and a comparison of European and American guidelines for reprocessing flexible endoscopes are given. Differences in the classification of endoscopic devices, on the possibility of prion transmission, recommendations on staff training and protection, quality assurance of reprocessing and evidence-based graduation of guidelines are stressed and discussed. With respect to the procedure of endoscope reprocessing, differences concerning the cleaning solution to choose, necessity of thoroughly manual cleaning and brushing of the accessible endoscope channels (even in the case of subsequent automatic reprocessing endoscopes in washers-disinfectors), disinfection solution, microbiological quality of water for final rinsing and rationale for alcohol flush of endoscope channels for better drying are mentioned. The need for experimental investigations of the cleaning and disinfection process is stressed. In contrast to recent guidelines of European and American societies of gastrointestinal endoscopy, the now updated recommendations of the Robert Koch-Institute for reprocessing flexible endoscopes and endoscopic accessories are evidence-based and graduated.     

Computer equipment used in patient care within a multihospital system: recommendations for cleaning and disinfection

Computer hardware has been implicated as a potential reservoir for infectious agents. Leaders of a 22-hospital system, which spans North America and serves pediatric patients with orthopedic or severe burns, sought to develop recommendations for the cleaning and disinfection of computer hardware within its myriad patient care venues. A task force comprising representatives from infection control, medical affairs, information services, and outcomes management departments was formed. Following a review of the literature and of procedures within the 22 hospitals, criteria for cleaning and disinfection were established and recommendations made. The recommendations are consistent with general environmental infection control cleaning and disinfection guidelines, yet flexible enough to be applicable to the different locales, different computer and cleaning products available, and different patient populations served within this large hospital system.     

Saudi Arabian Society of Echocardiography Recommendations for Echocardiography Service During Corona Virus Disease 2019 (COVID-19) Outbreak

We are summarizing the recommendations for the use of Echocardiography in patients during COVID-19 pandemic. The patient risk for COVID-19 should be assessed according to the Saudi CDC guidelines. Echocardiography should only be performed of considered appropriate and will likely alter the clinical decision. In COVID-19 suspected/confirmed patients, echocardiography study should be performed bedside and in infection control approved area with airborne precaution. Limited focused imaging is recommended to minimize contact time. A dedicated machine for COVID-19 suspected/confirmed cases is recommended. Transesophageal echocardiography is considered an aerosol generating procedure; therefore, an alternative modality should be strongly considered. In COVID-19 suspected/confirmed patients, a transesophageal echocardiogram should be done only under strict airborne precaution. In low risk patient for COVID-19, Transesophageal echocardiography should be done with a minimum of droplet precaution, however; N95 respirator is preferred to surgical mask in this situation.     

Disinfection of gastrointestinal endoscopes and accessories

Abstract A worldwide concern has emerged with regard to endoscope disinfection and many gastrointestinal endoscopy associations have developed guidelines for proper disinfection of endoscopes and endoscopic accessories. A working party was convened to formulate guidelines for the Asia–Pacific region, pertaining to any setting in which gastrointestinal endoscopy is performed. Endoscope reprocessing that meets the established standard of practice helps to ensure a microbial-free endoscope for all patients, reduces the risk of disease transmission and helps to prolong the life of the endoscope. The recommendations included mechanical cleaning as the first and most important step followed by immersion in 2% glutaraldehyde for a minimum period of 10 min. Automated disinfectors have been recommended for busy endoscopy centres to ensure better compliance. Reuse of endoscopic accessories meant for 'single use' remains a controversial issue. Strict quality assurance programmes are a must to preclude lack of compliance with these guidelines.     

Value and limitations of transesophageal echocardiography in assessment of mitral valve prostheses

BACKGROUND. Transthoracic Doppler echocardiography examination has become an integral part of the investigations performed in patients with mitral valve prostheses. The limitations of the transthoracic approach are well documented. Transesophageal echocardiography provides a unique window for achieving a clear view of the mitral prosthesis. METHODS AND RESULTS. This study shows the usefulness of transesophageal echocardiography in clinical practice for assessment of patients with a mitral valve prosthesis. This technique demonstrated an abnormality in 48% of patients who had normal results on transthoracic examination. The overall sensitivity of transesophageal echocardiography was 96%. CONCLUSIONS. Transesophageal echocardiography constitutes an essential part of a comprehensive two-dimensional/Doppler echocardiographic examination in patients with suspected malfunction of mitral prostheses.     

Value of transesophageal echocardiography as an adjunct to transthoracic echocardiography in evaluation of native and prosthetic valve endocarditis

To determine if transesophageal echocardiography provides better visualization of valvular vegetations than transthoracic echocardiography, we used both methods to evaluate 24 consecutive patients (mean age, 54 years; 15 female patients and nine male patients) referred for symptoms suggestive of infectious endocarditis. Ten of the 24 patients had one or more valvular prostheses. Echocardiograms were classified as positive or negative based on visualization of valvular vegetations or abscesses. Of ten patients with a final diagnosis of infectious endocarditis on extended follow-up, transthoracic echocardiography was positive in five patients. Transesophageal echocardiography not only yielded abnormal findings in all ten of these patients, but also revealed additional information in four of the five patients with abnormal transthoracic echocardiographic examinations. Among the 14 patients who, on subsequent follow-up, were found not to have infectious endocarditis, transthoracic echocardiography was normal in 13 and falsely abnormal in one. Transesophageal echocardiography revealed no evidence of infectious endocarditis in any of these patients. The ten patients who were determined to have infectious endocarditis all had positive blood cultures and no alternative cause for their clinical presentation; in seven patients in this group who underwent operative or postmortem evaluation, infectious endocarditis was confirmed. All patients without infectious endocarditis were demonstrated to have other causes for their clinical presentation. We conclude that transesophageal echocardiography is a highly valuable test in the work-up of patients with suspected infectious endocarditis, especially those patients with inconclusive or normal transthoracic echocardiograms. In addition, transesophageal echocardiography may be of benefit to patients with previously documented infectious endocarditis and a complicated clinical course in whom additional cardiac lesions are suspected but not demonstrated by transthoracic echocardiography.     

Transgastric: A forgotten view for atrial septal defect device closure procedures?

Percutaneous closure of an atrial septal defect in the cardiac catheterization laboratory requires noninvasive imaging to assist in characterization of the atrial septal defect and deployment of the device. Transesophageal echocardiography is the modality most often used in these circumstances. Transesophageal echocardiographic guidelines exist for the assessment and guidance for atrial septal defect closures, but these guidelines do not mention transgastric views. In this case, we demonstrate that transgastric views are helpful in describing the atrial septal defect, especially as it concerns the inferior vena cava rim.     

Cleaning and disinfection of equipment for gastrointestinal flexible endoscopy: interim recommendations of a Working Party of the British Society of Gastroenterology.

1. All patients undergoing gastrointestinal endoscopy must be considered 'at risk' for HIV and appropriate cleaning/disinfection measures taken for endoscopes and accessories. 2. Thorough manual cleaning with detergent, of the instrument and its channels is the most important part of the cleaning/disinfection procedure. Without this, blood, mucus and organic material will prevent adequate penetration of disinfectant for inactivation of bacteria and viruses. 3. Aldehyde preparations (2% activated glutaraldehyde and related products) are the recommended first line antibacterial and antiviral disinfectant. A four minute soak is recommended as sufficient for inactivation of vegetative bacteria and viruses (including HIV and HBV). 4. Quaternary ammonium detergents (8% Dettox for two minutes for bacterial disinfection), followed by exposure of the endoscope shaft and channels to ethyl alcohol (70% for four minutes for viral inactivation), is an acceptable second-line disinfectant routine where staff sensitisation prevents the use of an aldehyde disinfectant. 5. Accessories, including mouthguards and cleaning brushes, require similarly careful cleaning/disinfection, before and after each use. Disposable products (especially injection needles) may be used and appropriate items can be sterilised by autoclaving and kept in sterile packs. 6. Closed circuit endoscope washing machines have advantages in maintaining standards and avoiding staff sensitisation to disinfectants. Improved ventilation including exhaust extraction facilities may be required. 7. Endoscopy staff should receive HBV vaccination, wear gloves and appropriate protective garments, cover wounds or abrasions and avoid needlestick injuries (including spiked forceps, etc). 8. Known HIV-infected or AIDS patients are managed as immunosuppressed, and require protection from atypical mycobacteria/cryptosporidia etc, by one hour aldehyde disinfection of endoscopic equipment before and after the procedure. A dedicated instrument is not required. 9. Increased funding is necessary for capital purchases of GI endoscopic equipment, including extra and immersible endoscopes with additional accessories to allow for safe practice. 10. Greater numbers of trained GI assistants are needed to ensure that cleaning/disinfection recommendations and safety precautions are followed, both during routine lists and emergency endoscopic procedures. 11. These recommendations are based on expert interpretation of current data on infectivity and disinfection; they may require future modification.     

Fibre-optic bronchoscopy in adults: a position paper of The Thoracic Society of Australia and New Zealand

Abstract
Fibre-optic bronchoscopy in adults is a common procedure in clinical respiratory practice. Under controlled conditions it is safe, resulting in relatively few significant adverse events. The present position paper updates guidelines previously published by The Thoracic Society of Australia and New Zealand and is based on evidence obtained by searching the Medline and Embase databases. The level of evidence to support recommendations is indicated in the text. Where no evidence has been found, the guidelines reflect the opinions of the authors. Specific recommendations are made regarding sedation and anaesthesia, the cleaning of bronchoscopes and the training of bronchoscopists. (Intern Med J 2001; 31: 479–487)     

Diagnostic flexible bronchoscopy. Recommendations of the Endoscopy Working Group of the French Society of Pulmonary Medicine

These guidelines on flexible bronchoscopy depict important clues to be known and taken into account while practicing flexible bronchoscopy, in adult, except in emergency situations. This is a practical clarification. Safety conditions, complications, anesthesia, infectious risks, cleaning and disinfection are detailed from a review of the literature. Intensive care practice of bronchoscopy requires more attention due to higher risks patients and is discussed extensively. Standards and performances of the various sampling techniques complete this work. Indications for bronchoscopy, therapeutic and paediatric bronchoscopy are not covered in these guidelines.