Barzilai B, Dávila-Román V G, Eaton M H, Rosenbloom M, Spray T L, Wareing T H, Cox J L, Kouchoukos N T
Cardiovascular Division, Washington University School of Medicine, St. Louis, MO 63110.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1410-6.
Transesophageal echocardiography has been found to be an effective technique for the real-time assessment of myocardial and valvular function in postoperative patients. To determine the value of transesophageal echocardiography in patients with mechanical assist devices, we performed daily, bedside transesophageal echocardiography on 16 patients with right (n = 3), left (n = 1), or biventricular assist devices (n = 12). We obtained four-chamber and short-axis views in all patients. Valvular function and the presence of left-to-right shunts were evaluated by means of color flow Doppler imaging. During the echocardiographic study ventricular assist device flow was diminished to less than 1.5 L/min, and inotropic agents (dobutamine or epinephrine) were given to assess ventricular reserve. Changes in day-to-day ventricular function were assessed in comparisons made by two observers (one unaware of the study sequence) using a semiquantitative method for wall motion analysis. The left ventricular wall motion scores in the patients successfully weaned from left or biventricular assist devices (n = 5) improved (14.2 +/- 1.6 versus 8.2 +/- 1.5, p < 0.0001). The scores did not improve in patients who remained dependent on the devices (n = 8). Two patients with only right ventricular assist devices were successfully weaned after documentation of improvement of right ventricular function by transesophageal echocardiography. Transesophageal echocardiography documented a clot compressing the heart in three patients; intracavitary thrombi were seen in two other patients. Marked hemodynamic improvement occurred after surgical decompression. In conclusion, transesophageal echocardiography is a safe, effective method for the assessment of ventricular function of patients on ventricular assist device support. In addition, it allows one to assess valvular function and the presence or absence of impaired ventricular filling.
经食管超声心动图已被证明是一种实时评估术后患者心肌和瓣膜功能的有效技术。为了确定经食管超声心动图在使用机械辅助装置患者中的价值，我们对16例使用右心室（n = 3）、左心室（n = 1）或双心室辅助装置（n = 12）的患者进行了每日床边经食管超声心动图检查。我们对所有患者均获取了四腔心和短轴视图。通过彩色多普勒血流成像评估瓣膜功能及左向右分流情况。在超声心动图检查期间，将心室辅助装置的血流减少至低于1.5 L/分钟，并给予正性肌力药物（多巴酚丁胺或肾上腺素）以评估心室储备。由两名观察者（其中一名不了解研究顺序）采用半定量壁运动分析方法进行比较，评估每日心室功能的变化。成功脱离左心室或双心室辅助装置的患者（n = 5）左心室壁运动评分得到改善（14.2±1.6对8.2±1.5，p < 0.0001）。仍依赖装置的患者（n = 8）评分未改善。两名仅使用右心室辅助装置的患者在经食管超声心动图证实右心室功能改善后成功脱离装置。经食管超声心动图显示3例患者有血栓压迫心脏；另外2例患者可见心腔内血栓。手术减压后血流动力学有显著改善。总之，经食管超声心动图是评估接受心室辅助装置支持患者心室功能的一种安全、有效的方法。此外，它还能评估瓣膜功能以及心室充盈是否受损。
