超声心动图对改良体肺分流术后疗效的评价与随访

目的 应用经胸超声心动图对实施改良体肺分流术后患者的肺血管和心室的发育进行随访研究.方法 收集35例实施改良体肺分流术后且随访6个月以上的患者资料,分别记录手术前后的肺动脉内径及左心室内径变化,观察分流管道的血流速度和管道通畅情况.结果 体肺分流手术当天即实施再次体肺分流管道外科干预3例.患者随访期为(21.2±11.3)月,其中7例患者发现分流管堵塞;随访期内体肺分流术后主肺动脉和左右肺动脉内径平均增加31.2%,左心室舒张末内径增加25.6%.随访期内有19例患者接受Ⅱ期手术,与继续随访等待Ⅱ期手术者相比,肺动脉发育程度相差显著(P＜0.05).接受Ⅱ期手术者二维超声测得的肺动脉值与造影检查中测得者比较两组差异无统计学意义(P＞0.05).结论 超声在改良体肺分流术的评价中起着重要的作用,包括对围手术期及术后分流管道通畅性的评价,及心室和肺血管发育的评估,从而为Ⅱ期手术提供可靠的依据.

Postoperative echocardiographic evaluation of modified Blalock-Taussig shunts

0bjective To summarize the experience of postoperative and mid-term echocardiographic evaluation of modified Blalock-Tasussig(BT)shunts. Methods During 2003-2006,thirty five consecutive patients received modified BT shunts and survived postoperative 6 months were enrolled in this study.Transthoracic echocardiography was utilized to evaluate the patency of shunts and the change of pulmonaryarteries(PA)and left ventricle(LV). Results Three patients received the emergence surgery for the intervention for the BT shunts. The follow-up was (21.2±11.3) months. During the follow up,the obstruction of shunts occurred in 7 cases. After the placement of shunts,the mean size of PA increased by 31.2%,meanwhile,the size of LV increased by 25.6%. Nineteen patients received the followed definitive repair or palliative operations. Compared with the patients still waiting for the growth of PA,the patients who receiving the second staged procedure achieved the more appropriate PA growth. Furthermore,for the above patients,there was no significant difference between the angiographic and echocardiographic evaluation for the PA size. Conclusions Echocardiography could accurately diagnose the patency of shunts and record the growth of PA and LV following BT shunts. Echocardiography is a highly reliable noninvasive approach for the perioperative evaluation and mid-term follow-up for the modified BT shunts.