Jeng Chuen-Shin, Huang I-Ren, Lin Chen-Jung, Lin Chih-Peng, Cheng Ya-Jung
Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 2003 Dec;41(4):205-8.
We present a successful thromboembolectomy under intraoperative transesophageal echocardiography (TEE) monitoring on a woman with massive pulmonary embolism (PE). Sudden onset of dyspnea happened 7 days after lumbar spine surgery and ventilation/perfusion scan and angiography performed right away were suggestive of PE. Operation was performed 17 days later after invalid anticoagulant treatments and unavailing catheter fragmentation. Intraoperative TEE showed massive emboli in the main and right pulmonary arteries (MPA and RPA) and dilated right atrium (RA) with deviated intraatrial septum. Removal of the emboli was performed smoothly under TEE monitoring. The dilation of RA, right ventricle (RV) and PA were resolved soon after thromboembolectomy. The patient was extubated the next day with obvious improvement of clinical symptoms and discharged two weeks later without neurological sequale. We conclude that TEE can be an excellent tool not only for early diagnosing PE in high risk patients but also for intraoperative monitoring on removing emboli and managing cardiac functions.
我们报告了一例在术中经食管超声心动图（TEE）监测下成功进行血栓切除术的病例，患者为一名患有大面积肺栓塞（PE）的女性。腰椎手术后7天突然出现呼吸困难，随即进行的通气/灌注扫描和血管造影提示为PE。在抗凝治疗无效且导管碎栓失败后17天进行了手术。术中TEE显示主肺动脉和右肺动脉（MPA和RPA）内有大量栓子，右心房（RA）扩张，房间隔偏移。在TEE监测下顺利取出栓子。血栓切除术后，RA、右心室（RV）和肺动脉的扩张很快得到缓解。患者于次日拔管，临床症状明显改善，两周后出院，无神经后遗症。我们得出结论，TEE不仅可以作为早期诊断高危患者PE的优秀工具，还可以用于术中监测栓子清除和心脏功能管理。
