术中经食管超声心动图对心脏瓣膜置换术后即刻评估的价值研究

目的:研究术中经食管超声心动图对心脏瓣膜置换术(HVR)后即刻评估的价值。方法:选取168例行心脏瓣膜置换术患者,均在术中行经食管超声心电图检查,记录主动脉瓣环内径及钙化斑块情况,计算主动脉瓣内直径;观察并记录心脏收缩功能情况,血管内血栓、钙化及钙化斑块大小情况;术后观察人工瓣膜是否成功,重点分析心脏收缩、血容量及瓣膜闭合等情况。比较所有患者手术前后的瓣膜及心功能情况,分析术中经食管超声心动图对HVR术后即刻评估的价值。结果:经食管超声心动图三维检查检测的主动脉瓣环内径及钙化检出情况与手术病理结果相比,差异无统计学意义。在术中行经食管超声心动图发现,2例患者存在生物瓣瓣叶脱垂及缝线勒住生物瓣瓣脚情况,为在机体应力状态下人工瓣膜对合不良影响瓣叶功能,遂均更换相同型号瓣膜,更换后瓣环内反流消失。168例患者术后主动脉平均跨膜压差明显低于术前水平,左室射血分数及有效瓣口面积指数水平明显高于术前,差异有统计学意义(t=20.352,t=32.784,t=22.583;P<0.001)。所有患者均完成HVR,其中6例患者(生物瓣瓣叶脱垂1例、缝线勒住生物瓣瓣脚1例、拆除后离体检测碟片运动无异常的主动脉瓣机械瓣关闭不全1例、机械瓣碟片启闭不灵活且经调整碟片方向仍无改善的二尖瓣3例)更换新的人工瓣膜。所有患者术后恢复顺利,未发生院内死亡。结论:经食管超声心动图应用于HVR术中的临床价值较高,可及时确定人工瓣膜功能异常,协助判断内源性因素并给予及时补救,有助于为提高手术有效保障,对临床治疗效果进行真实性评估,有效提高HVR成功率。

Study on the value of intraoperative transesophageal echocardiography on the postoperatively immediate assessment of HVR

Objective:To study the value of intraoperative transesophageal echocardiography on the immediate assessment of heart valve replacement(HVR).Methods:168 patients who underwent heart valve replacement were selected as the research objects.All patients were examined by transesophageal echocardiography during the surgery.The inner diameter of aortic valve ring and calcified plaque were recorded,and the internal diameter of aortic valve was further calculated.And the cardiac systolic function,intravascular thrombus,calcification and the size of calcified plaque also were observed and recorded.After the surgery,the successive situation of the artificial valve was observed,and the cardiac systole,blood volume and valve closure were especially analyzed.The valve and heart function of all patients between before and after surgery were compared.And the value of intraoperative transesophageal echocardiography on the immediate evaluation of HVR was analyzed at the last.Results:There were no significant difference in the inner diameter of aortic valve ring and calcification between the three-dimensional detection of transesophageal echocardiography.The results of postoperative transesophageal echocardiography showed that two patients had bioprosthetic valve prolapse and their bioprosthetic valve foot were strangled by suture.Considering the unfavorable folding of the artificial valve under the state of body stress might affect the function of valve leaflet,all the valves of them were replaced with the same model,and then the regurgitation within the valve ring was eliminated after the replacement.The mean transmembrane pressure difference of 168 patients of postoperative aorta was significantly lower than that of preoperative aorta,and the left ventricular ejection fraction and the index of effective valve area postoperative aorta were significantly higher than that preoperative aorta(t=20.352,t=32.784,t=22.583,P<0.001).All patients completed HVR,among which,6 patients(1 case was bioprosthetic valve prolapse,and 1 case’s suture strangled bioprosthetic valve foot,and 1 case’s mechanical valve of aortic valve was insufficiency and his disc motion in vitro detection was not abnormal after removal,and 3 cases whose start and stop of the disc of mechanical valve were inflexible and whose disc direction didn’t be improved through regulated the direction of disc)replaced new artificial valve.All patients recovered smoothly and there was no death during hospital days.Conclusion:The application of transesophageal echocardiography has higher clinical value in HVR.It can determine the abnormal function of artificial valve in time,and help to judge the endogenous factors and give timely remedy,and help to improve the effective guarantee of surgery,and implement the authenticity assessment for clinical treatment effect and improve the success rate of HVR.