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手术室中经食管超声心动图的多普勒组织速度、应变及应变率成像:一项可行性研究。

Doppler tissue velocity, strain, and strain rate imaging with transesophageal echocardiography in the operating room: a feasibility study.

作者信息

Simmons Lisa A, Weidemann Frank, Sutherland George R, D'hooge Jan, Bijnens Bart, Sergeant Paul, Wouters Patrick F

机构信息

Department of Cardiology, University Hospital, Katholieke Universiteit Leuven, Belgium.

出版信息

J Am Soc Echocardiogr. 2002 Aug;15(8):768-76. doi: 10.1067/mje.2002.120504.

Abstract

OBJECTIVE

Transesophageal echocardiography (TEE) is increasingly used to monitor regional myocardial function during cardiac operation. Doppler myocardial imaging (DMI) indices can potentially provide new information on regional radial and longitudinal myocardial motion and local deformation. This study examined the feasibility of TEE acquisition of regional radial and longitudinal velocity, displacement (D), strain, and strain rate data during cardiac operation and evaluated the effects of sternotomy and pericardial opening on these indices.

METHODS

After a baseline transthoracic echocardiographic study, TEE was performed in 22 patients (age 64 +/- 7 years) before sternotomy, after sternotomy with intact pericardium, and after pericardial opening. Regional DMI velocity analysis was performed for the transgastric anterior and inferior walls midpapillary segment (radial function) and the 4-chamber septum and 2-chamber inferior walls basal, mid, and apical segments (longitudinal function). For each segment, systolic and diastolic velocity were derived and D, strain, and strain rate calculated.

RESULTS

Transthoracic echocardiographic study and TEE provided similar data from an equivalent number of interpretable segments. In the basal and mid septum, maximum longitudinal systolic D decreased with pericardial opening (basal septum pericardium closed: 6.6 +/- 1.5 mm, open: 4.6 +/- 1.8 mm, P =.007; midseptum pericardium closed: 4.7 +/- 2.5 mm, open: 2.7 +/- 1.5 mm, P =.028). No changes were evident in systolic or diastolic DMI indices in all other segments.

CONCLUSION

DMI with TEE is feasible during cardiac operation. During pericardial opening, longitudinal D decreases in the septum, but not in the inferior wall. DMI requires further evaluation in the assessment of ventricular function and the detection of ischemia in the operating room.

摘要

目的

经食管超声心动图(TEE)越来越多地用于心脏手术期间监测局部心肌功能。多普勒心肌成像(DMI)指标有可能提供有关局部径向和纵向心肌运动及局部变形的新信息。本研究探讨了在心脏手术期间通过TEE获取局部径向和纵向速度、位移(D)、应变及应变率数据的可行性,并评估了胸骨切开术和心包切开术对这些指标的影响。

方法

在进行基线经胸超声心动图检查后,对22例患者(年龄64±7岁)在胸骨切开术前、胸骨切开后心包完整时以及心包切开后进行TEE检查。对经胃前壁和下壁乳头肌中段(径向功能)以及四腔心间隔和两腔心下壁基底、中间和心尖段(纵向功能)进行局部DMI速度分析。对于每个节段,得出收缩期和舒张期速度,并计算D、应变及应变率。

结果

经胸超声心动图检查和TEE从同等数量的可解释节段提供了相似的数据。在心包切开后,基底和中间间隔的最大纵向收缩期D降低(基底间隔心包关闭时:6.6±1.5mm,心包开放时:4.6±1.8mm,P = 0.007;中间间隔心包关闭时:4.7±2.5mm,心包开放时:2.7±1.5mm,P = 0.028)。所有其他节段的收缩期或舒张期DMI指标均无明显变化。

结论

在心脏手术期间使用TEE进行DMI是可行的。在心包切开时,间隔的纵向D降低,但下壁未降低。DMI在手术室评估心室功能和检测缺血方面需要进一步评估。

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