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。
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.
关键词
肺动脉瓣闭锁 /
婴儿 /
超声心动描记术
Key words
Pulmonary atresia /
Infant /
Echocardiography
中图分类号：
Ｒ722.1
Ｒ541.1
Ｒ540.45
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