经食管心房起搏联合经胸二维超声心动图：大动脉转位动脉调转术患者的手术经验

Transoesophageal atrial pacing combined with transthoracic two dimensional echocardiography: experience in patients operated on with arterial switch operation for transposition of the great arteries.

作者信息

De Caro E, Ussia G P, Marasini M, Pongiglione G

机构信息

Servizio di Cardiologia, Istituto G Gaslini Children's Hospital, Genoa, Italy.

出版信息

Heart. 2003 Jan;89(1):91-5. doi: 10.1136/heart.89.1.91.

DOI:10.1136/heart.89.1.91

PMID:12482802

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1767519/

Abstract

OBJECTIVE

To assess the feasibility, safety, and diagnostic accuracy of transoesophageal atrial pacing stress echocardiography (TAPSE) combined with two dimensional transthoracic echocardiography (TTE) for evaluation of coronary perfusion in patients undergoing arterial switch operation for transposition of the great arteries.

DESIGN

TAPSE combined with TTE was performed at the end of cardiac catheterisation. An ischaemic response was defined as > 1.5 mm horizontal or downsloping ST segment depression or as a new or worsened wall motion abnormality. The results were compared with results of coronary angiography.

SETTING

Tertiary referral centre for paediatric cardiology and cardiac surgery.

PATIENTS

25 patients, mean (SD) age 29.5 (19) months, mean (SD) weight 12.5 (3.4) kg.

MAIN OUTCOME MEASURES

Target heart rate (200 beats/min) was attained in 22 of 25 (88%) patients. Electrocardiographic ischaemic changes occurred in 4 of 25 (16%) and wall motion abnormalities in 3 of 25 (12%). Coronary obstructions were found in 2 of 25 (8%) patients.

RESULTS

The test was feasible in all patients, without clinical complications requiring treatment. Compared with coronary angiography, the test had a sensitivity and a specificity of 100% and 95%, respectively, for the echocardiographic stress, and of 100% and 91%, respectively, for the electrocardiographic stress. The negative predictive value was 100% for both the echocardiographic and the electrocardiographic stress tests. The positive predictive value was 66% for the echocardiographic stress and 50% for the electrocardiographic stress tests.

CONCLUSIONS

In these patients TAPSE combined with TTE was feasible and safe and apparently an accurate diagnostic method for evaluation of coronary perfusion. Patients with a negative test may have a low likelihood of major coronary abnormalities and may not require coronary angiography.

摘要

目的

评估经食管心房起搏负荷超声心动图（TAPSE）联合二维经胸超声心动图（TTE）用于评估大动脉转位行动脉调转术患者冠状动脉灌注的可行性、安全性及诊断准确性。

设计

在心脏导管检查结束时进行TAPSE联合TTE检查。缺血反应定义为ST段水平或下斜型压低>1.5mm，或出现新的或加重的室壁运动异常。将结果与冠状动脉造影结果进行比较。

设置

儿科心脏病学和心脏外科三级转诊中心。

患者

25例患者，平均（标准差）年龄29.5（19）个月，平均（标准差）体重12.5（3.4）kg。

主要观察指标

25例患者中有22例（88%）达到目标心率（200次/分钟）。25例患者中有4例（16%）出现心电图缺血性改变，25例患者中有3例（12%）出现室壁运动异常。25例患者中有2例（8%）发现冠状动脉阻塞。

结果

该检查在所有患者中均可行，无需要治疗的临床并发症。与冠状动脉造影相比，该检查对超声心动图负荷试验的敏感性和特异性分别为100%和95%，对心电图负荷试验的敏感性和特异性分别为100%和91%。超声心动图和心电图负荷试验的阴性预测值均为100%。超声心动图负荷试验的阳性预测值为66%，心电图负荷试验的阳性预测值为50%。