Erbel R, Drexler M, Metzger F, Ellmauer S, Jacob H, Iversen S, Oelert H, Meyer J
II. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität,Mainz.
Z Kardiol. 1990;79 Suppl 4:127-40.
Two-dimensional echocardiography including color Doppler techniques can be used for analysis of the morphology and function and of the blood flow of the heart and the great vessels. Epicardial echocardiography has the advantage of high resolution and multiple scan planes. The restriction to the intraoperative period is a clear disadvantage. In addition, the scan planes are difficult to standardize. Transesophageal echocardiography can be used for monitoring during the whole operative period but is restricted to horizontal and/or longitudinal scan planes. It is a non-contact procedure and thus, sterile conditions are not affected. For evaluation of surgical success, intraoperative echocardiography can be used for analysis in patients with congenital heart disease, mitral valve regurgitation, hypertrophic obstructive cardiomyopathy, and aortic dissection. Acute intraoperative revisions with a second extracorporal circulation period will avoid reoperation. In patients with coronary artery disease the flow within the bypass and also the status of the anastomosis can be scanned and may contribute to reduce the perioperative infarct rate. Intraoperative echocardiography needs additional costs and man power. Only after randomized comparative prospective studies have demonstrated that patients controlled by intraoperative echocardiography have a better outcome and prognosis than patients without intraoperative control this method will become routine in open-heart surgery.
二维超声心动图，包括彩色多普勒技术，可用于分析心脏和大血管的形态、功能及血流情况。心外膜超声心动图具有高分辨率和多扫描平面的优势。其局限于手术期是一个明显的缺点。此外，扫描平面难以标准化。经食管超声心动图可在整个手术期用于监测，但仅限于水平和/或纵向扫描平面。它是一种非接触式检查，因此不会影响无菌条件。为评估手术成功率，术中超声心动图可用于分析患有先天性心脏病、二尖瓣反流、肥厚性梗阻性心肌病和主动脉夹层的患者。在体外循环的第二个阶段进行急性术中修正可避免再次手术。对于冠心病患者，可扫描旁路内的血流以及吻合口的状况，这可能有助于降低围手术期梗死率。术中超声心动图需要额外的费用和人力。只有在随机对照前瞻性研究表明，接受术中超声心动图监测的患者比未接受术中监测的患者有更好的结局和预后之后，这种方法才会成为心脏直视手术的常规操作。
