术前经胸超声心动图术中经食管超声心动图对二尖瓣反流的分级对比

目的:通过术前经胸超声心动图(POTTE)与术中体外循环前经食管超声心动图(IOTEE)对二尖瓣反流(MR)分级的对比,评价2种检查结果有无差异、原因及影响因素。方法:回顾性调查研究200例MR手术患者,对比POTTE与IOTEE的MR分级诊断。结果:2者结果一致者143例(占71.5%,Kappa=0.56,r=0.71,P<0.01)。与POTTE相比,IOTEE分级加重者19例(9.5%),多见于瓣膜器质性损害和偏心性反流;IOTEE分级减轻者38例(19%),多见于功能性相对关闭不全和中心性反流。在无～微量及严重MR者,2种检查结果较一致;而在少、中量MR,2者差异较大。IOTEE时有外科意义(中～严重)MR由132例(66%)减至111例(56%),有减轻MR分级倾向。与术前相比,麻醉后患者循环改变明显(P<0.01)。结论:多数MR患者,POTTE与IOTEE分级诊断结果一致,但这2种检查不能相互替代。POTTE分级结果更能反映生理负荷下MR严重程度。IOTEE有确诊作用,但分级MR时需参考术前循环指标。     

术中经食管超声心动图评估主动脉粥样硬化斑块的意义

目的：研究心脏直视手术中经食道超声心动图（ＴＥＥ）检测升部、弓部主动脉粥样硬化斑块的意义。方法：８０例心脏直视手术患者在术中行ＴＥＥ检查，平均年龄６３．６±８．４岁，其中６９（８６．３％）例冠状动脉重建术（ＣＡＢＧ）。当检出有意义斑块时，选择性地行七项相关的修改手术方案。结果：共检出升部、弓部主动脉有意义斑块分别有２例和１９例。根据ＴＥＥ的发现修改手术方案３０次。本研究无一例围术期脑血管意外并发症，仅３例一过性脑缺血发作。结论：在设备条件许可时，６５岁以上心脏直视手术患者尤其是ＣＡＢＧ，术中应行ＴＥＥ检查和监测。当检出有意义斑块时，应及时修改手术方案，可降低围术期脑血管意外并发症。     

经食管超声诊断胸主动脉疾病

报道对临床疑诊胸主动脉疾病而行食管超声（ＴＥＥ）检查的患者共４７例，ＴＥＥ诊断主动脉夹层１８例，主动脉扩张１５例，正常９例，其它５例。通过分析胸主动脉疾病的ＴＥＥ诊断特征，并与手术结果、减数血管造影及磁共振成象进行对比研究，结果显示ＴＥＥ在胸主动脉疾病诊断中具有重要、独特的价值。     

心脏直视手术中经食管超声心动图描记术的临床研究

目的：探讨术中经食管超声心动图描记术（ＩＴＥＥ）的临床应用价值。方法：回顾性研究总结１０６例接受ＩＴＥＥ检查的患者。结果：６６．０％的患者行瓣膜手术，其中包括二尖瓣成形术、二尖瓣替换术、主动脉瓣替换术、三尖瓣成形术及主动脉瓣、二尖瓣双瓣替换术；１２．３％的患者行左心室流出道疏通术；１１．３％的患者行带瓣主动脉替换术；１０．４％的患者行先天性心脏病矫治术，其中２例患者行经皮穿刺心房间隔缺损钮扣装置封堵术。结论：ＩＴＥＥ能即时评价人工瓣膜位于体内的功能状态，检出瓣周漏；准确地判断左心室流出道疏通的效果；ＩＴＥＥ检查在经皮穿刺缺损封堵术中也有较大的应用潜力。     

经食管超声心动图临床应用体会

<正>经食管超声心动图(TEE)因采用接近心脏的特殊探查位置和优质的图像显示,开拓了心脏大血管影像学检查的新视野,弥补了传统的经胸超声心动图(TTE)的某些不足,尤其是后方心内结构,如房间隔、左侧心瓣膜、及左侧心腔病变的可视性,已被临床广泛应用。本文回顾性总结我院开展TEE检查的188     

床旁经胸超声心动图在急性主动脉夹层Stanford细化分型中的应用价值

目的:本文旨在评价床旁经胸超声心动图在急性主动脉夹层(aortic dissection,AD)Stan-ford细化分型中的应用价值。方法:回顾分析经手术证实的52例急性主动脉夹层患者,男性35例,女性17例;年龄18～71岁,平均(52±11)岁的手术结果和经胸超声心动图表现及主动脉夹层采用Stanford细化分型方法。超声心动图分析的内容包括:内膜片、破口、主动脉瓣反流程度、冠状动脉、主动脉弓部3血管分支及窦管交界形态,主动脉窦部、弓部及胸腹主动脉内径。结果:52例AD Stanford细化分型如下:A1S型2例,A1C型1例,A2S型2例;A2C型9例,A3S型2例,A3C型14例,B1S型3例,B2S型5例,B2C型2例,B3S型10例,B3C型2例。经胸超声心动图结果:除3例漏诊外其余49例分型如下:A1S型4例,A1C型1例,A2S型1例;A2C型4例,A3S型5例,A3C型15例,B1S型3例,B1C型1例,B2S型4例,B2C型1例,B3S型8例,B3C型2例。结论:经胸超声心动图有助于诊断AD Stanford细化分型,具有重要的临床应用价值。     

经胸超声心动图在主动脉窦瘤及其合并症诊断中的应用价值

目的探讨经胸超声心动图(TTE)对主动脉窦瘤及其合并症诊断的应用价值。方法回顾分析2007年10月至2014年3月北京军区总医院超声科应用经胸超声心动图诊断的15例主动脉窦瘤患者,男性11例,女性4例,年龄范围23~75岁,平均年龄(40.93±17.06)岁。应用TTE诊断主动脉窦瘤及主动脉窦瘤破裂合并室间隔缺损,并计算诊断的敏感性、特异性、阳性预测值、阴性预测值以及准确度。分析各病理分型及其合并症图像特征,与术中所见进行对比。结果 15例患者中,窦瘤破裂8例(53.3%),平均年龄(32.25±7.85)岁;未破裂7例(46.7%),平均年龄(50.85±19.81)岁。窦瘤破裂患者的平均年龄较未破裂患者高,差异有统计学意义(P0.05)。以外科术中所见为金标准,TTE诊断主动脉窦瘤破裂的敏感性、特异性、阳性预测值、阴性预测值、准确度分别为100%(8/8)、85.7%(6/7)、88.8%(8/9)、100%(6/6)和93.3%(14/15),诊断主动脉窦瘤破裂合并室间隔缺损分别为50%(3/6)、100%(9/9)、100%(3/3)、75%(9/12)和80%(12/15)。根据超声图像进行病理分型,除1例无法分型外,Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型所占比例分别为26.67%(4/15)、46.67%(7/15)、0%和20%(3/15)。14例患者术中测量窦瘤基底宽度与TTE测量结果差异无统计学意义(P=0.77)。结论 TTE可准确诊断主动脉窦瘤及其合并症,对窦瘤进行病理分型,对主动脉窦瘤诊疗工作具有重要价值。     

经胸及经食管超声心动图诊断无顶冠状静脉窦综合征

目的:探讨无顶冠状静脉窦综合征(UCSS)的超声心动图特点及诊断价值。方法:回顾性分析经手术证实为UCSS的18例患者的资料。可疑UCSS时结合经食管超声心动图检查,观察经胸超声心动图不同切面(心尖或胸骨旁短轴四腔心切面、右心室流入道切面、剑突下双心房切面)的超声表现,并对其分型。结果:经胸超声心动图明确诊断12例,术前经胸超声心动图结合经食管超声心动图明确诊断17例,超声诊断符合率94.4%(17/18)。18例患者中,Ⅰ型2例,Ⅱ型11例,Ⅲ型5例(术前超声诊断4例,术中经食管超声心动图发现1例)。术前经胸超声心动图3个切面均可显示Ⅰ型患者;心尖或胸骨旁短轴四腔心切面显示Ⅱ型9例,Ⅲ型4例;右心室流入道切面显示Ⅱ型5例,Ⅲ型4例;剑突下双心房切面显示Ⅱ型10例,Ⅲ型4例。结论:经胸超声心动图结合经食管超声心动图检查,有利于术前明确诊断UCSS,减少漏诊、误诊。     

经食管超声心动图评价人工心脏瓣膜的功能

本文利用经胸及经食管超声技术观察了51例人工瓣膜置换术后的瓣膜功能及反流程度,并比较了两种技术在评价人工瓣膜中的优缺点。结果表明:(1)经食管超声心动图(TEE)在观察左房及左心耳血栓,判定二尖瓣位人工机械瓣反流程度及鉴别反流与瓣周漏方面均优于经胸超声心动图(TTE)技术,(2)TEE在检出人工二尖瓣反流方面明显优于TTE,且TEE及TTE对人工二尖瓣反流的检出率分别为87.76%和14.29%,(3)TEE在检出主动瓣反流方面与TTE比较,无显著性差异(P>0.05),但可低估瓣膜反流程度。经食管超声技术是判定二尖瓣位人工瓣功能异常的敏感、可靠方法。     

三维食管超声心动图在经胸小切口房间隔缺损封堵术中的应用

目的：探讨实时三维经食管超声心动图（RT-3D TEE ）在监测经胸小切口房间隔缺损（ASD ）封堵术的作用。方法初步筛查适合封堵术的ASD患者30例,缺损大小6mm～32mm ,房间隔残缘≥5mm。术前采用经胸超声心动图（TTE）重点测量房间隔总长度、房间隔缺损的最大径、房间隔残缘软边的长度;术中采用RT-3D TEE监测,并测量房间隔总长度、房间隔缺损的最大径、房间隔残缘软边的长度,与术前检查结果进行比较。术后1～12个月进行随访。结果30例经胸小切口ASD封堵术全部成功,没有出现需要进一步处理的意外。经食管超声心动图（TEE ）在识别房间隔总长度、软边长度方面均优于TTE ,两者在测量房间隔缺损最大径方面无统计学意义,RT-3D TEE成像显示房间隔缺损立体影像图。结论经胸小切口ASD封堵术中应用经食管超声心动图对于选择合适病例、封堵器型号、指导封堵过程以及疗效评价方面具有重要作用并优于经胸超声心动图,配备实时三维成像功能检查效果更理想。     

Transesophageal Echocardiography in Thoracic Aortic Atherosclerosis

Transesophageal echocardiography opened a new window to the thoracic aorta and for the first time permitted in vivo imaging of aortic atherosclerotic disease. The technique is useful in assessing the extent of the disorder, its complications, and possible treatment modalities. It will also be useful in the assessment of the progression as well as the possible regression of the disorder with appropriate (dietary or chemical) therapy.     

Rupture of Aortic Dissection During Attempted Transesophageal Echocardiography

Transesophageal echocardiography (TEE) provides a rapid and accurate diagnosis in patients with dissection of the thoracic aorta. The procedure is considered to be safe. We report a case where rupture of a dissecting thoracic aneurysm occurred during attempted TEE in a patient, who had been clinically stable for 1 week. TEE was performed because aortic valve endocarditis was suspected, and the procedure did not include close surveillance of the blood pressure. Careful manipulation of the probe, adequate sedation, monitoring, and treatment of acute rises in blood pressure was recommended in patients with even a slight suspicion of dissection undergoing TEE.     

Transesophageal Echocardiography in the Evaluation of Aortic Trauma

Transesophageal echocardiography (TEE) is superior to other imaging techniques for the diagnosis of aortic trauma. It can accurately, rapidly, and safely diagnose life-threatening conditions such as aortic rupture, pseudoaneurysm, traumatic aortic dissection, and intramural hematoma. TEE is useful for the diagnosis and prevention of iatrogenic aortic trauma induced by cardiovascular surgery, intraaortic procedures, and cardiopulmonary resuscitation.     

Diagnosis of Supravalvular Aortic Stenosis by Transesophageal Echocardiography

The role of transesophageal echocardiography (TEE) in diagnosis of disorders of the thoracic aorta is well established. In this report the TEE findings in an adult patient with supravalvular aortic stenosis are presented. This showed narrowing of the ascending aorta just above the sinuses, due to fibromuscular thickening, causing an hour-glass shaped deformity. The excellent image quality obtained by TEE is far superior to transthoracic echocardiography. Coronary artery ostial obstruction a known association of supravalvular aortic stenosis can be caused by different mechanisms including adherence of the aortic valve leaflet to the ridge of obstructive muscle or premature atherosclerosis. TEE can define the mechanism of coronary artery ostial obstruction associated with supravalvular aortic stenosis.     

Left Brachiocephalic Vein Mimicking an Aortic Dissection on Transesophageal Echocardiography

Transesophageal echocardiography has gained widespread acceptance for the diagnosis of aortic dissection; however, little attention has been paid to the pitfalls that may be encountered. The left brachiocephalic vein can mimic a localized aortic dissection. The features that distinguished this vein from an aortic dissection are: the lack of the characteristic oscillating motion of an intimal flap; the pattern of flow within the vein; the tubular nature of the vein is seen using the sagittal imaging plane; and an injection of agitated saline into a left arm vein will show contrast enhancement of the left brachiocephalic vein.     

Diagnosis of Contained Aortic Rupture by Transesophageal Echocardiography

Hematogenous seeding is the most common mechanism for the development of peripheral arterial infections. Echocardiography, and especially transesophageal echocardiography, has played an increasingly important role in the diagnosis of aortic pathology. Rupture of an aortic aneurysm is difficult to diagnose antemortem, and requires a high index of suspicion and a rapid diagnosis if surgery is to be beneficial. We present a case of a ruptured aortic aneurysm secondary to seeding from B. fragilis bacteremia suspected by transesophageal echocardiography and confirmed by surgical exploration. The two-dimensional echocardiographic and color flow Doppler findings are described and differentiated from those seen in an aortic dissection.     

Atypical Aortic Dissection Diagnosed by Transesophageal Echocardiography

This case report describes a patient in whom a thin dissection of the proximal aorta was diagnosed by transesophageal echocardiography. Dissection was not firmly diagnosed in our patient with computed tomography, angiography, or magnetic resonance imaging. A definitive diagnosis was made prospectively using intraoperative transesophageal echocardiography by demonstrating the presence of a thin immobile dissection flap located very close to the anterior aortic wall. Color Doppler examination showed absence of flow signals in the small false lumen, suggesting that it may be clotted. At surgery the presence of dissection involving the ascending aorta, as well as a clotted false lumen were confirmed. This finding demonstrates the utility of transeophageal echocardiography in the diagnosis of aortic dissection and the ability of this test to differentiate a thin dissection from intimal thickening. (ECHOCARDIOGRAPHY, Volume 11, May 1994)