Kaulitz R, Stümper O, Fraser A G, Kreis A, Tuccillo B, Sutherland G R
Echo Department Thoraxcenter, Erasmus University Rotterdam, The Netherlands.
Int J Cardiol. 1990 Sep;28(3):299-307. doi: 10.1016/0167-5273(90)90312-s.
Following a Mustard's procedure, transoesophageal echocardiography allowed the visualization of all 4 pulmonary veins in 7/12 patients (mean age 14.8 years) and of three veins in a further 2 patients. Both upper pulmonary veins could be visualized consistently. No patient had an isolated pulmonary venous stenosis. In 9 patients in sinus rhythm, computer analysis of Doppler tracings from the left upper pulmonary vein showed significantly lower systolic peak velocities (mean 0.39 +/- 0.10 m/s) and time velocity integrals (mean 6.9 +/- 1.66 cm) than in normal subjects (mean 0.6 +/- 0.09 m/s and 14.4 +/- 2.97 cm respectively; P less than 0.001). We postulate that this is due to compromised atrial relaxation and compliance. In contrast, patients in junctional rhythm (mean 10.7 vs. 7.7 cm in normal subjects). Flow reversal during early ventricular systole (due to tricuspid regurgitation or atrial contraction after retrograde conduction during junctional rhythm) was detected in 6/12 patients. These results confirm that the transoesophageal approach should allow the identification of isolated pulmonary venous obstruction after a Mustard procedure. In addition. detailed analysis of tracings of flow in the pulmonary veins can document the presence of compromised atrial relaxation and help to evaluate the severity of tricuspid regurgitation. It may provide a new index with which to assess impaired systemic ventricular function.
在进行Mustard手术之后，经食管超声心动图检查显示，12例患者中有7例（平均年龄14.8岁）可清晰观察到全部4条肺静脉，另有2例可观察到3条肺静脉。双侧上肺静脉均可持续清晰显示。无一例患者存在孤立性肺静脉狭窄。在9例窦性心律患者中，对左上肺静脉的多普勒描记图进行计算机分析显示，其收缩期峰值速度（平均0.39±0.10米/秒）和时间速度积分（平均6.9±1.66厘米）显著低于正常受试者（分别为平均0.6±0.09米/秒和14.4±2.97厘米；P<0.001）。我们推测这是由于心房舒张和顺应性受损所致。相比之下，交界性心律患者（正常受试者平均为7.7厘米，此处平均为10.7厘米）。12例患者中有6例在心室收缩早期检测到血流逆转（由于三尖瓣反流或交界性心律时逆行传导后的心房收缩）。这些结果证实，经食管途径应可识别Mustard手术后的孤立性肺静脉梗阻。此外，对肺静脉血流描记图的详细分析可证实心房舒张受损的存在，并有助于评估三尖瓣反流的严重程度。它可能提供一个评估体循环心室功能受损的新指标。
