Kim Hyun Koo, Kim Woong-Han, Hwang Sung Wook, Lee Jae Young, Song Jin Young, Kim Soo-Jin, Jang Ki Young
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea.
Ann Thorac Surg. 2005 Jul;80(1):56-9. doi: 10.1016/j.athoracsur.2005.01.060.
Intraoperative transesophageal echocardiography and follow-up transthoracic echocardiography have been useful in assessing cardiac function in complete atrioventricular septal defects. However, it has been suggested that a discrepancy exists between intraoperative and postoperative findings, and that intraoperative findings cannot reliably predict long-term results. This study aims to determine whether this discrepancy exists and to assess whether it is possible to predict follow-up results using intraoperative transesophageal echocardiography.
A retrospective analysis was made in 35 patients who underwent biventricular repair by one surgeon between November 1997 and January 2004. All patients received intraoperative transesophageal echocardiography and follow-up transthoracic echocardiography at 19.1 +/- 18.02 months (range, 7 days to 5 years; median, 15.1 months).
In left-sided atrioventricular valve regurgitation, 34.3% (12 of 35) of patients showed discrepancy during follow-up, and 28.6% (10 of 35) showed progression of regurgitation (from grade I to II). In right-sided atrioventricular valve, 11.4% (4 of 35) of patients showed discrepancy, 9.6% (3 of 35) showed progression of regurgitation (from grade I to II).
In complete atrioventricular septal defects, intraoperative transesophageal echocardiography did not show the same findings as that of follow-up transthoracic echocardiography in some cases. However, this discrepancy is not so great as to require reoperation in early to midterm follow-up. Therefore, intraoperative transesophageal echocardiography may be used as tool to predict durability of surgical results and to decrease the incidence of reoperation in complete atrioventricular septal defects.
术中经食管超声心动图及术后随访经胸超声心动图在评估完全性房室间隔缺损患者的心功能方面很有用。然而，有人提出术中与术后结果之间存在差异，且术中结果无法可靠地预测长期效果。本研究旨在确定这种差异是否存在，并评估使用术中经食管超声心动图预测随访结果是否可行。
对1997年11月至2004年1月间由同一外科医生进行双心室修复的35例患者进行回顾性分析。所有患者均接受了术中经食管超声心动图检查，并在19.1±18.02个月（范围7天至5年；中位数15.1个月）时接受了术后随访经胸超声心动图检查。
在左侧房室瓣反流方面，34.3%（35例中的12例）患者在随访期间出现差异，28.6%（35例中的10例）出现反流进展（从I级到II级）。在右侧房室瓣方面，11.4%（35例中的4例）患者出现差异，9.6%（35例中的3例）出现反流进展（从I级到II级）。
在完全性房室间隔缺损中，术中经食管超声心动图在某些情况下的表现与术后随访经胸超声心动图不同。然而，这种差异在早期至中期随访中并不严重到需要再次手术。因此，术中经食管超声心动图可作为预测手术结果持久性和降低完全性房室间隔缺损再次手术发生率的工具。
