Voci P
Department of Cardiac Surgery, La Sapienza, University of Rome, Italy.
Eur Heart J. 1992 Aug;13(8):1146-52. doi: 10.1093/oxfordjournals.eurheartj.a060328.
Intra-operative echocardiography is becoming a reference standard for the evaluation of the results of cardiac surgery. Myocardial contrast echocardiography has been recently introduced to study regional myocardial blood flow and cardioplegia distribution in patients undergoing coronary artery surgery. It can be used in three different stages: before cardiopulmonary bypass, to identify the most hypoperfused myocardial segments; during cardioplegic arrest, to check the adequacy of myocardial protection; postoperatively, to assess graft patency. The priority in revascularization can be assigned according to the regional perfusion pattern, which depends not only on coronary artery narrowing, but also on the extent of collateral circulation. The distribution of cardioplegia to the myocardium can be monitored in real time with clear identification of poorly protected myocardial segments. The injection in the graft after weaning from cardiopulmonary bypass allows assessment of graft patency and measurement of the 'area at risk' for graft occlusion. In conclusion, the information obtained in the operating theatre by myocardial contrast echocardiography is original and promises to have a significant impact on surgical strategy. Implementation of the ultrasonic equipment to obtain quantitative on-line data on myocardial blood flow is desirable.
术中超声心动图正成为评估心脏手术结果的参考标准。心肌对比超声心动图最近已被引入，用于研究冠状动脉手术患者的局部心肌血流和心脏停搏液分布。它可用于三个不同阶段：在体外循环前，识别灌注最差的心肌节段；在心脏停搏期间，检查心肌保护的充分性；术后，评估移植血管通畅情况。血运重建的优先级可根据局部灌注模式来确定，该模式不仅取决于冠状动脉狭窄程度，还取决于侧支循环的范围。心脏停搏液向心肌的分布可实时监测，明确识别保护不佳的心肌节段。在脱离体外循环后向移植血管内注射造影剂，可评估移植血管通畅情况，并测量移植血管闭塞的“危险区域”。总之，通过心肌对比超声心动图在手术室获得的信息具有创新性，有望对外科手术策略产生重大影响。理想的做法是采用超声设备获取关于心肌血流的定量在线数据。
