经心外膜超声心动图在冠状动脉旁路移植术中的应用价值

目的：应用经心外膜超声心动图（ IEE）检查接受冠状动脉旁路移植术（ CABG）的患者，评价该超声技术在CABG术中的应用价值。方法选取31例冠心病患者（单纯冠心病20例，合并高血压病6例、合并瓣膜病5例），分别用IEE观察CABG术前、术后心肌的收缩功能，瓣膜的形态、位置及启闭活动，血管吻合口处的血流情况等。结果 IEE术中发现6例患者左心收缩活动减弱，提示低心排血量；2例患者发现冠状动脉左前降支中段拟吻合口处有钙化斑块，改远端吻合后检测血流良好；1例患者见升主动脉根部拟吻合处有钙化斑块，改变吻合口位置后，血流情况良好；1例患者拟行二尖瓣成形术，后因二尖瓣反流显著导致成形困难，遂改植入机械瓣，术后IEE未探及异常反流和瓣周漏，余患者未见明显异常。结论 IEE能准确观测心脏的结构及舒缩功能，及时、清晰地显示桥血管吻合处的血流情况，指导手术操作方法和吻合口位置的选择，在CABG术中具有十分重要的临床意义。

Application value of intraoperative epicardial echocardiography in coronary artery bypass grafting

Objective To evaluate the value of intraoperative epicardial echocardiography ( IEE) in patients with coronary ar?tery bypass grafting ( CABG) . Methods 31 patients with coronary heart disease ( 20 cases of simple coronary heart disease, 6 cases with hypertension, 5 cases with valvular disease) were selected. IEE were used to observe the systolic function of CABG, the shape and position of the valve, and the blood flow at the anastomosis of the blood vessel before and after the operation. Results Left ventricular systolic activity decreased in 6 patients during IEE, suggesting a low cardiac output; calcification plaque of 2 cases was found in the middle of the left anterior descending branch of the left anterior descending artery, and the blood flow was good after changing the posi?tion of the distal anastomosis;calcified plaque of one case was found in ascending aortic root, the blood flow was good after changing the location of the anastomosis;one case planned to undergomitral valve plasty. Due to forming difficulties caused by mitral regurgita?tion, mechanical valve was implanted, and abnormal reflux and paravalvular leakage was not detected postoperative IEE. The remaining patients had no obvious abnormalities. Conclusion IEE can accurately observe cardiac structure and shrinkage function, timely and clearly display blood flow of bridge vascular anastomosis, guide the selectionof operation method and location of anastomosis, and has very important clinical significance in CABG.