经食道超声心动图在小婴儿室间隔完整型肺动脉瓣闭锁镶嵌治疗中的应用价值

doi:DOI:10.12117/jccmi.2019.08.008

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：探讨经食道超声心动图（TEE）在小婴儿室间隔完整型肺动脉瓣闭锁（PA/IVS）镶嵌治疗中的应用价值。方法：25例PA/IVS的小婴儿，在术前通过经胸超声心动图（TTE）确诊。气管插管全身麻醉后，所有患儿被插入TEE探头，评估肺动脉瓣环及右心室的发育情况，指导术者选择合适的球囊。通过TEE来引导穿刺针刺破肺动脉瓣，并监测输送鞘和球囊置入肺动脉。在TEE监测下所有患儿行球囊扩张术，然后用TEE评估扩张的即刻效果。结果：所有患儿在TEE引导下，均成功进行了肺动脉瓣的球囊扩张术，在术中未发生严重并发症。通过TEE发现，88.0%的患儿肺动脉瓣的前向血流通畅，80.0%的患儿出现轻度的肺动脉瓣关闭不全，80.0%的患儿三尖瓣关闭不全的程度明显减轻。有3例患儿在术后出现肺动脉瓣血流速度>3.0 m/s，在术后10~25月行右室流出道重建术。结论：TEE能够对PA/IVS患儿进行准确的术前评估，在镶嵌治疗中能够实时监测鞘管及球囊的置入，可以即刻评估扩张的效果。TEE是一种安全、有效监测小婴儿PA/IVS镶嵌治疗的方法。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	邹鹏
	孙善权
	刘琴
	黄景思
	许伟滨
	李虹

关键词 ：肺动脉瓣闭锁, 婴儿, 超声心动描记术

Abstract：Objective: To explore application values of transesophageal echocardiograghy(TEE) in the hybrid therapy to balloon pulmonary valvuloplasty for young infants of pulmonary atresia with intact ventricular septum(PA/IVS). Methods: Twenty-five young infants with PA/IVS were diagnosed by transthoracic echocardiography(TTE) before operation. After general anesthesia with endotracheal intubation, all patients were inserted TEE probe to evaluate development of pulmonary valve annulus and right ventricle and instruct the surgeon to select the appropriate balloon. Pulmonary valve was punctured by needle, and then sheath and balloon were inserted with the guidance of TEE. All patients were performed by the balloon pulmonary valvuloplasty monitored by TEE, and the effect of valvuloplasty was evaluated by TEE immediately. Results: All patients were performed successfully for balloon pulmonary valvuloplasty with the guidance of TEE, and no severe complications occurred during the operation. The forward flow of pulmonary valve was unobstructed in 88.0% of the patients, and 80.0% of the patients had mild pulmonary valve insufficiency. The degree of tricuspid valve insufficiency was significantly reduced in 80.0% of the patients. The pulmonary valve blood flow velocity in the three patients was more than 3.0 m/s after surgery, who had to need right ventricle outflow tract reconstruction 10~25 months after balloon pulmonary valvuloplasty. Conclusions: TEE accurately makes preoperative evaluation for the patients with PA/IVS, real-time monitors the placement of sheath and balloon during operation, and may evaluate the effect of dilation immediately. TEE is a safe and effective guidance technique for the hybrid therapy of young infant patients with PA/IVS.

Key words： Pulmonary atresia Infant Echocardiography

收稿日期: 2019-03-04

PACS:	Ｒ722.1
	Ｒ541.1
	Ｒ540.45

通讯作者: 李虹，广东省妇幼保健院心脏中心，511442。

作者简介: 邹鹏（1980-），男，辽宁丹东人，主治医师。

引用本文:

邹鹏，孙善权，刘琴，黄景思，许伟滨，李虹. 经食道超声心动图在小婴儿室间隔完整型肺动脉瓣闭锁镶嵌治疗中的应用价值[J]. 中国临床医学影像杂志, 2019, 30(8): 562-565.
ZOU Peng, SUN Shan-quan, LIU Qin, HUANG Jing-si, XU Wei-bin, LI Hong. Application values of transesophageal echocardiograghy in hybrid therapy for pulmonary atresia with intact ventricular septum in young infants. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(8): 562-565.

链接本文:

http://www.jccmi.com.cn/CN/DOI:10.12117/jccmi.2019.08.008 或 http://www.jccmi.com.cn/CN/Y2019/V30/I8/562

[1]Nykanen DG. Pulmonary atresia and intact ventricular septum[M]//Allen HD, Driscoll DJ, Shaddy RE, et al. Moss and Adams Heart Disease in Infants, Children and Adolescents. 7th ed. Philadelphia: Williams & Wilkins, 2008: 859-878. [2]Zheng JH, Gao BT, Zhu ZQ, et al. Surgical results for pulmonary atresia with intact ventricular septum: A single-centre 15-year experience and medium-term follow-up[J]. Eur J Cardiothorac Surg, 2016, 50(6): 1083-1088. [3]Marasini M, Gorrieri PF, Tuo G, et al. Long-term results of catheter-based treatment of pulmonary atresia and intact ventricular septum[J]. Heart, 2009, 95(18): 1520-1524. [4]Zampi JD, Hirsch-Romano JC, Goldstein BH, et al. Hybrid approach for pulmonary atresia with intact ventricular septum: early single center results and comparison to the standard surgical approach[J]. Catheter Cardiovasc Interv, 2014, 83(5): 753-761. [5]Li S, Chen W, Zhang Y, et al. Hybrid therapy for pulmonary atresia with intact ventricular septum[J]. Ann Thorac Surg, 2011, 91(5): 1467-1471. [6]Lin MC, Wei Hj, Fu YC, et al. A novel hybrid therapy for pulmonary atresia with intact ventricular septum[J]. Int J Cardiol, 2010, 144(3): 438-439. [7]Pettersen MD, Du W, Skeens ME, et al. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study[J]. J Am Soc Echocardiogr, 2008, 21(8): 922-934. [8]Bulkley BH, D’Amico B, Taylor AL, et al. Extensive myocardial fiber disarray in aortic and pulmonary atresia relevance to hypertrophic cardiomyopathy[J]. Circulation, 1983, 67(1): 191-198. [9]李虹，陈欣欣，庄建，等. 室间隔完整型肺动脉瓣闭锁介入治疗与外科手术的临床对比[J]. 中华胸心血管外科杂志，2009，26（2）：87-89. [10]Lin Z, Chen Q, Cao H, et al. Transthoracic balloon pulmonary valvuloplasty for treatment of congenial pulmonary atresia patients with intact ventricular septum[J]. Med Sci Monit, 2017, 23(10): 4874-4879. [11]Hu R, Zhang H, Dong W, et al. Transventricular valvotomy for pulmonary atresia with intact ventricular septum in neonates: a single-centre experience in mid-term follow-up[J]. Eur J Cardiothorac Surg, 2015, 47(1): 168-172. [12]王智琪，莫绪明，孙剑，等. 小婴儿室间隔完整性膜性肺动脉闭锁外科镶嵌治疗[J]. 中国循环杂志，2014，29（1）：55-58. [13]陈俊，左维嵩，莫绪明，等. 经食管超声心动图在室间隔完整型肺动脉闭锁镶嵌治疗中的应用[J]. 中国超声医学杂志，2012，28（11）：1040-1043. [14]李虹，孙善权，邹鹏，等. 镶嵌手术治疗新生儿室间隔完整型肺动脉瓣闭锁及危重肺动脉瓣狭窄[J]. 中华胸心血管外科杂志，2017，33（5）：283-285.