Balmer Christian, Barron David, Wright John G C, de Giovanni Joe V, Miller Paul, Dhillon Rami, Brawn William J, Stümper Oliver
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom.
Cardiol Young. 2006 Oct;16(5):455-62. doi: 10.1017/S1047951106000618.
Intraoperative ultrasound was introduced to evaluate the adequacy of repair after surgical repair of congenital cardiac malformations. Our purpose was to review the evolution of this technique at our centre.
We evaluated all intraoperative ultrasound studies undertaken between 1997 and 2002, reviewing the data from 1997 through 2001 retrospectively, but undertaking a prospective audit of studies undertaken from 2002 onwards. In all, we carried out a total number of 639 intraoperative ultrasound studies, from a possible 2737 cardiac operations (23.3%), using the epicardial approach in 580 (90.7%), and transoesophageal ultrasound in the other 59 patients (9.3%). Median age was 0.6 years, with an interquartile range from 0.06 to 3.6 years.
The findings obtained using intraoperative ultrasound influenced the surgical management in 63 of the 639 patients (9.9%), suggesting the need for additional surgery in 26, adjustment of the band placed round the pulmonary trunk in 16, preoperative assessment of the cardiac malformation in 5, and confirming the need for prolonged support with cardiopulmonary bypass for impaired ventricular function in 16. There were 18 early reoperations, 5 of which may have been predicted by intraoperative ultrasound. Of the 183 studies reviewed prospectively in 2002, it was not possible to obtain the complete range of views in 8 (4.4%), while in 27 patients (14.7%), the postoperative findings using transthoracic interrogation differed from the findings obtained immediately following bypass.
Intraoperative ultrasound is an important technique for monitoring the results of complex congenital cardiac surgery. The immediate recognition of significant lesions, together with multidisciplinary discussion, allows for improved management and prevention of early surgical reintervention.
引入术中超声以评估先天性心脏畸形手术修复后的修复充分性。我们的目的是回顾该技术在我们中心的发展历程。
我们评估了1997年至2002年间进行的所有术中超声检查，回顾了1997年至2001年的数据，采用回顾性研究，但对2002年以后进行的研究进行前瞻性审核。总共进行了639次术中超声检查，占可能进行的2737例心脏手术的23.3%，其中580例（90.7%）采用心外膜途径，另外59例（9.3%）采用经食管超声。中位年龄为0.6岁，四分位间距为0.06至3.6岁。
在639例患者中有63例（9.9%）术中超声检查结果影响了手术管理，其中26例提示需要再次手术，16例提示需要调整围绕肺动脉主干的束带，5例提示需要对心脏畸形进行术前评估，16例提示因心室功能受损需要延长体外循环支持时间。有18例早期再次手术，其中5例可能可通过术中超声预测。在2002年前瞻性审核的183例检查中，8例（4.4%）无法获得完整的视野，而在27例患者（14.7%）中，经胸检查术后结果与体外循环后立即获得的结果不同。
术中超声是监测复杂先天性心脏手术结果的重要技术。对重大病变的即时识别，结合多学科讨论，有助于改善管理并预防早期手术再次干预。
