经食管超声心动图在二尖瓣成形术中的应用价值

目的探讨经食管超声心动图在二尖瓣成形术中的应用价值。方法术前18例二尖瓣关闭不全患者均常规经胸超声心动图检查,术中经食管超声心动图监测,并即刻评价二尖瓣成形术的效果。结果本组18例中16例一次性手术实施成功。1例术中监测发现反流2级后再次实施成形后成功,1例术中监测发现反流3级后改行二尖瓣置换术。结论经食管超声心动图在二尖瓣成形术中具有非常重要的临床应用价值。     

实时三维经食道超声心动图在二尖瓣成形术中应用的研究进展

实时三维经食管超声心动图(RT-3D-TEE)是2007年新兴的一种检查技术,RT-3D-TEE是将食管超声与实时三维技术的优势相结合,它能够提供心脏各部位的实时动态图像,图像清晰、立体感强,与实体解剖形态十分相近。术中经食管超声因其不干扰手术视野,可实时监测手术过程等优点而广泛用于心     

超声心动图在二尖瓣成形术中的应用

目的探讨超声心动图用在二尖瓣成形手术中的应用价值。方法将超声心动图用于31例二尖瓣关闭不全患者，指导手术适应证的选择并评价手术效果。结果31例患者中29例成功实施二尖瓣成形术，2例行瓣膜置换术；7例行术中食管超声监测。术后二尖瓣返流明显减少，左心房内径与左心室舒张末内径缩小，与术前比较，P〈0．05。结论超声心动图可初步指导二尖瓣病变手术方案并对术后疗效进行评价。     

术中经食管超声心动图监测行二尖瓣成形术

目的　评价术中经食管超声心动图在二尖瓣成形术中的作用。方法　 1993年 3月至 2 0 0 3年 3月 ,6 2例二尖瓣关闭不全病人在经食管超声心动图监测下行二尖瓣成形术 ,男 2 4例 ,女 38例 ,平均年龄 (31 3± 7 5 )岁。病因为退行性变 4 2例 ,先天性 2 0例。重度二尖瓣关闭不全 5 9例 ,中度 3例。根据二尖瓣病变的特征进行相应的成形手术。结果　全组无一例手术死亡 ,8例改行二尖瓣替换术。术后超声心动图检查二尖瓣无返流 3例 ,轻度返流 4 9例 ,中度返流 2例。结论　经食管超声心动图在术中能即时判断二尖瓣成形术的效果 ,并找出失败原因 ,从而指导进一步成形术。     

术中经食管超声心动图在微创二尖瓣成形手术中的应用

目的:探讨经食管超声心动图(TEE)指导下胸腔镜辅助微创二尖瓣成形手术的疗效。方法:回顾性分析2017年1月至2019年11月在上海交通大学医学院附属仁济医院因二尖瓣关闭不接受TEE指导下胸腔镜辅助微创二尖瓣成形手术的患者82例,其中男性57例,女性25例,年龄22～75岁。采用股动脉、股静脉插管建立外周体外循环、阻闭升主动脉,HTK心脏停搏液顺行灌注行心肌保护,胸腔镜辅助微创右胸小切口行二尖瓣成形及相关手术。结果:82例接受二尖瓣成形术患者均植入成形环。其中手术1次转机成形成功80例。术后TEE及出院前复查超声心动图提示二尖瓣未见明显狭窄或反流,无二尖瓣收缩期前向运动。随访79例患者,随访时间(22±10)个月,复发二尖瓣中重度关闭不全1例,二尖瓣轻度反流9例,随访期间无死亡。结论:TEE指导下胸腔镜辅助微创二尖瓣成形手术提高了手术精度,避免了外科医生对病变性质、范围、严重程度的误判,降低了手术难度。     

超声心动图在二尖瓣重建术中的应用

本文旨在对超声心动图在二尖瓣重建术前决策、人工瓣环合理选择、术中和术后疗效的评估及今后的发展方向做一概述.     

小型经食道超声心动图在新生儿中的应用

经食道超声心动图 (ＴＥＥ)在儿科心脏手术和心脏介入心导管引导过程中能提供即刻解剖、功能和血液动力学方面的评价作用。但目前使用的标准ＴＥＥ探头 ,即双平面ＴＥＥ探头较粗 (尖部直径 9.1～ 9.5ｍｍ ,体部直径 8ｍｍ ) ,很少能安全应用于体重低于 2 .5千克的新生儿。因此 ,需要小型ＴＥＥ对小婴儿进行心内修补术和减轻复杂损害的心血管手术的检测。采用小型经食道超声心动图 (尖端装有一个小型超声换能器 ,固定在一个 10Ｆ ,直径 3.3ｍｍ ,长 90ｃｍ的导管上 ,可纵平面扫描 90度视野范围 ,但导管无水平成像功能 ,也无热敏电阻器来探测…     

房间隔缺损封堵术经食道超声心动图的监测

目的 研究不同年龄组经食道超声心动图（TEE）引导Amplatzer 房间隔缺损（ASD）封堵器经导管治疗ASD术中及术后所观察切面.方法 术前经TEE筛选235例继发孔型ASD患者,在TEE引导下测量ASD最大伸展径,选择适当型号的Amplatzer 封堵器经导管送至左房封堵ASD.结果 所有封堵术技术成功率100%,完成手术后即刻TEE监护,分别从食道中段双心房切面,四腔心切面,大动脉短轴切面及纵轴上下腔静脉观察ASD残端,杂音情况,术后残余分流等.成人组及老年组均有明显差异.结论 总结出TEE引导封堵术中成年组及老年组的标准切面及每一切面所观察内容,对监测不同年龄段ASD封堵术术中术后具有重要指导意义.     

经食道心脏超声心动图在临床心脏外科中的应用价值

目的 评价多平面经食道超声心动图(TEE)在心外科的临床应用价值。方法 对209例经心脏外科手术证实心血管疾病患者进行回顾性研究，所有患者术前均采用经胸超声心动图(TTE)及TEE检查，采用诊断符合率比较，评价TTE、TEE的临床应用价值。结果 在主动脉瓣狭窄、二尖瓣狭窄、房间隔缺损、瓣膜关闭不全、感染性心内膜炎、左房血栓、主动脉病变的诊断符合率方面TEE明显优于TTE(P＜0．05)。而在三尖瓣狭窄、肺动脉瓣狭窄、室间隔缺损、动脉导管未闭、左房粘液瘤的诊断符合率方面未见明显差异，但部分结果可能与病例数少有关。结论 TTE是常规诊断多种心血管疾病必要手段，多平面TEE较TTE有更为准确的诊断价值，且有利于指导心导管或手术治疗、判断病情、预后。     

The Role of Intraoperative Transesophageal Echocardiography in Robotic Mitral Valve Repair

Background: Robotic mitral valve (MV) repair is a new surgical technique that uses small incisions. Previous studies have demonstrated the importance of intraoperative transesophageal echocardiography (TEE) for conventional MV surgery with the use of a median sternotomy incision. The aim of the present study was to delineate the utility of intraoperative TEE in robotic MV repair. Methods: Intraoperative TEE was performed in 22 consecutive patients undergoing robotic MV repair for severe degenerative mitral regurgitation (MR) over a period of 2 years. Before cardiopulmonary bypass (CPB), TEE was used to define the lesions of degenerative MR and the localization of the prolapsed leaflets, and to evaluate the severity of MR. During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was used to assess immediately the competency of the surgical repair. Results: Agreement between TEE and surgical findings was excellent: 92.3% (kappa, 0.873) for the lesions of degenerative MR, and 98.5% (kappa, 0.943) for the localization of the prolapsed leaflets. Under TEE guidance, all the cannulae (100%) in the SVC, IVC, and AAO were placed correctly. TEE demonstrated all the patients (100%) had successful robotic MV repairs. Conclusions: Intraoperative TEE is a valuable adjunct in the assessment of robotic MV repair. (Echocardiography 2011;28:85‐91)     

二尖瓣关闭不全的介入治疗新进展

为了减轻二尖瓣关闭不全外科手术和体外循环所带来的创伤和风险,基于外科边对边缝合和瓣环成形的手术方式,近年来二尖瓣关闭不全的介入治疗得到了快速发展,包括经二尖瓣边对边修补术和瓣环成形术,前者经穿房间隔途径送入钳夹装置或负压抽吸缝合装置,钳夹或缝合前后瓣边缘,形成双孔二尖瓣,后者经右颈内静脉途径把缩环装置植入冠状静脉窦内,缩短瓣环前后径,以减轻二尖瓣反流。两种方法均已从动物实验过渡到临床试验,均显示了良好的治疗作用,但还需技术上的进一步改进和长期大规模的临床评价。     

Values for Mitral Valve Annulus Dimensions in Normals and Patients with Mitral Regurgitation

Objectives. The present study was designed to investigate the dimensions of mitral valve annulus in the presence of mitral regurgitation. Method. Fifty-four patients were examined. On transthoracic echocardiographic images, we performed linear measurements in the parasternal plane in order to define the size of the left ventricle, left atrium, and mitral valve annulus. We compared these findings with those obtained in 16 control subjects. Results. Twenty-one patients with mild or moderate mitral regurgitation demonstrated no significant change of the mitral valve annulus compared with the control group (P > 0.05). Seventeen patients with severe mitral regurgitation (grade of 4) had a significant increase of the dimensions of the mitral valve annulus, left ventricle, and left atrium (P < 0.05). The etiology of mitral regurgitation was degenerative in 32 patients, rheumatic in 2 patients, and mitral valve prolapse in 4 patients. All patients had normal left ventricular systolic function. Thirty-one patients were in normal sinus rhythm, and seven were in atrial fibrillation. Conclusions. The measurement of the diameter of the mitral valve annulus is feasible with transthoracic echo-cardiography. In addition to the evaluation of mitral valve leaflets and subvalvular apparatus, the measurement of the mitral valve annulus is important in the evaluation of mitral regurgitation, as its enlargement is indicative for severe mitral regurgitation .     

Systolic Papillary Muscle Dyssynchrony Predicts Recurrence of Mitral Regurgitation in Patients with Ischemic Cardiomyopathy (ICM) Undergoing Mitral Valve Repair

Objective: We investigated the impact of papillary muscle dyssynchrony (DYS‐PAP) in predicting recurrent mitral regurgitation (MR) in patients with ischemic cardiomyopathy (ICM) undergoing undersized mitral ring annuloplasty (UMRA). Methods: One hundred forty‐four ICM patients (left ventricular ejection fraction <35%) in sinus rhythm undergoing UMRA between January 2001 and December 2010 at three Institutions (University Hospital, Maastricht, The Netherlands; Careggi Hospital, Florence, Italy; Civic Hospital, Brescia, Italy) were recruited. The primary endpoint was the recurrence of MR at the latest echocardiographic study defined as insufficiency ≥2+ in patients with no/trivial MR at discharge. The assessment of DYS‐PAP was performed by applying two‐dimensional (2D) speckle‐tracking imaging. Results: In patients with MR recurrence, DYS‐PAP significantly worsened (84.1 ± 8.8 msec vs.65.4 ± 8.8 msec at baseline, P < 0.001) whereas in patients with no MR recurrence, DYS‐PAP did not vary (22.3 ± 5.3 msec vs. 25.9 ± 7.2 msec at baseline, P = 0.8). Recurrent MR was positively correlated with preoperative DYS‐PAP (P < 0.001), baseline anterior mitral leaflet tethering angle α (P < 0.001) and tethering symmetry index α/β before surgery (P < 0.001). There was no significant correlation between MR recurrence and other echocardiographic parameters. Logistic regression analysis revealed that baseline values of DYS‐PAP (OR: 5.4 [95% CI: 3.1–7.7], P < 0.001), α (OR: 5.0 [2.6–6.7], P < 0.001), and α/β (OR: 3.9 [2.5–5.7], p < 0.001) were predictors of recurrent MR. A DYS‐PAP value ≥ 58 msec predicted recurrence of MR with 100% sensitivity and 83% specificity (area under the curve [AUC]: 0.92 [0.7–1], P < 0.001). Conclusions: A DYS‐PAP cutoff value of 58 msec is useful to identify patients in whom UMRA is likely to fail. That way decision making in ischemic functional MR might be facilitated.