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术中经食道超声心动图在急性Stanford A型主动脉夹层手术中的应用价值 |
刘曼薇,谢明星 |
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(华中科技大学同济医学院附属协和医院超声影像科) |
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摘要: |
目的 探讨术中经食道超声心动图(Transesophageal Echocardiography,TEE)在急性Stanford A型主动脉夹层(AAD)手术中的应用价值。 方法 选取经全主动脉CTA诊断为ADD的患者41例,术前行TEE检查,根据TEE检出主动脉根部受累情况分为三组:夹层未累及主动脉根部组(A组)16例,主动脉根部轻-中度受累组(B组)9例,主动脉根部重度受累组(C组)16例。均行术前TEE检查观察主动脉根部形态、夹层受累情况,包括主动脉瓣叶形态、功能,测量并比较各组主动脉瓣环内径、主动脉窦部内径、窦管交界内径及可显示升主动脉段的最大内径,观察冠状动脉起始段形态;术后TEE即刻观察手术效果。并将TEE结果与术中所见进行比较。结果 41例患者术前TEE对升主动脉内撕裂的内膜片显示阳性率为100%。B、C组主动脉窦部内径均大于A组,C组主动脉窦部内径大于B组,差异均有统计学意义(P<0.05);A、B、C三组患者主动脉瓣环及升主动脉内径比较差异均无统计学意义。经手术证实,术前TEE诊断夹层累及冠状动脉的特异性为62.5%,敏感性为56%。术后TEE可评估人工主动脉瓣或修复主动脉瓣形态、功能,以及人工血管、冠状动脉等吻合情况。结论 术前TEE能准确评估AAD主动脉根部及冠状动脉受累情况,术后TEE可即刻评估手术效果,具有重要的临床应用价值。 |
关键词: 急性A型主动脉夹层 术中经食道超声心动图 手术方案 |
DOI: |
投稿时间:2018-03-12修订日期:2018-04-13 |
基金项目: |
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Value of Transesophageal Echocardiography in Surgery of Acute Stanford Type A Aortic Dissection |
Liu Manwei,Xie Mingxing |
(Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology,Wuhan, China) |
Abstract: |
Objective To investigate the value of transesophageal echocardiography(TEE) in surgery of acute Stanford type A aortic dissection(AAD). Methods There were forty-one patients diagnosed as AAD by aortic computed tomography angiography in our research. Before aortic surgery,aortic root information can be diagnosed with TEE which was benefit in determining operation strategy. After TEE, patients are divided into three groups according to dissection scope and severity. Group A∶16 cases, AAD without dissection involving aortic root. Group B∶9 cases, AAD with mild to moderate dissection of aortic root. Group C∶16 cases, AAD with severe dissection of aortic root. Pre-operation TEE examine aortic root form,dissection scope,pattern and function of aortic valve. Diameter of aortic annulus, aortic sinus, the junction of the aortic sinus and displayable ascending aorta were measured and compared in each group with different parameters. In addition,TEE can be used to observe the clinical effect immediately after the surgery. Results All of 41 patients showed dissection in their ascending aorta using pre-operation TEE with the positive rate being 100%.No statistically significant differences in diameter of aortic annulus was found among group A,B and C. Diameter of aortic sinus of group B and C were significantly higher than those group A. Coronary arterial dissections can be checked out in operation in the some patients. The sensitivity of TEE was 56% and accuracy was 62.5%.Post-operation TEE can evaluate function of the artificial aortic valve or repaired aortic valve. And the artificial blood vessel and coronary artery anastomosis also can be checked by TEE. Conclusion Pre-operation TEE can assess aortic root helping to determine operation strategy and post-operation TEE can?evaluate the clinical effect immediately after the surgery. |
Key words: Acute Stanford type A aortic dissection Intraoperative Transesophageal echocardiography Operation strategy. |
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