Cabrera Schulmeyer M C, Santelices Cuevas E, Vega Sepúlveda R, Allamand F, De la Maza J C
Departamento de Anestesiología. Hospital Clinico Fuerza Aérea de Chile.
Rev Esp Anestesiol Reanim. 2005 Jun-Jul;52(6):367-70.
A 39-year-old hypertensive man with severe aortic stenosis underwent aortic valve replacement monitored by intraoperative transesophageal echocardiography. Upon weaning the patient off extracorporeal circulation, hemodynamics became severely compromised, with hypotension, tachycardia, and elevated precordial electrocardiographic tracings. The echocardiographic images were instrumental during the episode to demonstrate that the anterior wall presented hypokinesis consistent with ischemia in the region but that there were also images of hyperrefringence highly suggestive of intracoronary air embolism. Intraoperative transesophageal echocardiography allowed us to diagnose the real cause of the ischemic event and rule out an atheromatous plaque as the source. Perfusion pressure was increased to treat the air embolism. The echocardiographic image demonstrated success, specifically restoration of left ventricular regional contractility. This experience revealed the usefulness of transesophageal echocardiography in intraoperative monitoring to diagnose ischemia, assess the cause, and guide treatment.
一名39岁患有严重主动脉瓣狭窄的高血压男性接受了主动脉瓣置换术，术中采用经食管超声心动图监测。在患者脱离体外循环后，血流动力学严重受损，出现低血压、心动过速以及胸前区心电图描记升高。在这一过程中，超声心动图图像有助于显示前壁运动减弱，与该区域的缺血相符，但也有高回声图像，强烈提示冠状动脉内空气栓塞。术中经食管超声心动图使我们能够诊断缺血事件的真正原因，并排除动脉粥样斑块作为来源。增加灌注压力以治疗空气栓塞。超声心动图图像显示治疗成功，特别是左心室局部收缩力得以恢复。这一经验揭示了经食管超声心动图在术中监测诊断缺血、评估病因和指导治疗方面的有用性。
