利用平均压差和主动脉瓣面积对主动脉瓣狭窄进行分级：术前经胸超声心动图与体外循环前经食管超声心动图的比较

Grading Aortic Stenosis With Mean Gradient and Aortic Valve Area: A Comparison Between Preoperative Transthoracic and Precardiopulmonary Bypass Transesophageal Echocardiography.

作者信息

Whitener George, Sivak Joseph, Akushevich Igor, Samad Zainab, Swaminathan Madhav

机构信息

Department of Anesthesiology, Duke University.

Department of Cardiology, Duke University Medical Center.

出版信息

J Cardiothorac Vasc Anesth. 2016 Oct;30(5):1254-9. doi: 10.1053/j.jvca.2016.05.012. Epub 2016 May 11.

DOI:10.1053/j.jvca.2016.05.012

PMID:27495962

Abstract

OBJECTIVE

The authors hypothesized that average precardiopulmonary bypass (pre-CPB) transesophageal echocardiographic (TEE) mean gradient (PGm) and aortic valve area (AVA) values would be significantly different from preoperative transthoracic (TTE) values in the same patients and that these changes would affect pre-CPB TEE grading of aortic stenosis (AS).

DESIGN

Retrospective, observational design.

SETTING

Single university hospital.

PARTICIPANTS

The study comprised 92 patients who underwent aortic valve replacement with or without coronary artery bypass grafting between 2000 and 2012 at Duke University Hospital and who had PGm and AVA values recorded in both pre-CPB TEE and preoperative TTE reporting databases.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

PGm with pre-CPB TEE was lower by 6.6 mmHg (95% confidence interval, -4.0 to -9.3 mmHg; p<0.001), whereas AVA was higher by 0.10 cm(2) (95% confidence interval, 0.04 to 0.15 cm(2); p<0.001), compared with preoperative TTE values. When using PGm, pre-CPB TEE generated an AS severity 1 grade lower 39.1% of the time and revealed no difference 55.4% of the time compared to preoperative TTE. When using AVA by continuity, pre-CPB TEE generated an AS severity 1 grade lower 14.1% of the time and revealed no difference 81.5% of the time compared to preoperative TTE. When using either PGm or AVA, preoperative TTE exhibited moderate or severe AS for all study patients, whereas, pre-CPB TEE demonstrated mild AS in 5.4% (n = 92) of patients.

CONCLUSIONS

The authors confirmed their hypothesis that pre-CPB TEE generates different PGm and AVA values compared with preoperative TTE. These differences often underestimate AS severity. Hemodynamic standardizations or adjustments of pre-CPB TEE PGm and AVA values may be necessary in anesthetized patients before assigning an AS grade using these parameters.

摘要

目的

作者推测，在同一患者中，体外循环（CPB）前经食管超声心动图（TEE）的平均压差（PGm）和主动脉瓣面积（AVA）值与术前经胸（TTE）值会有显著差异，且这些变化会影响CPB前TEE对主动脉瓣狭窄（AS）的分级。

设计

回顾性观察性研究。

地点

单一大学医院。

参与者

该研究纳入了92例于2000年至2012年在杜克大学医院接受主动脉瓣置换术（无论是否行冠状动脉旁路移植术）的患者，这些患者的CPB前TEE和术前TTE报告数据库中均记录有PGm和AVA值。

干预措施

无。

测量指标及主要结果

与术前TTE值相比，CPB前TEE测得的PGm降低了6.6 mmHg（95%置信区间，-4.0至-9.3 mmHg；p<0.001），而AVA增加了0.10 cm²（95%置信区间，0.04至0.15 cm²；p<0.001）。使用PGm时，CPB前TEE得出的AS严重程度比术前TTE低1级的情况占39.1%，与术前TTE无差异的情况占55.4%。采用连续方程法计算AVA时，CPB前TEE得出的AS严重程度比术前TTE低1级的情况占14.1%，与术前TTE无差异的情况占81.5%。使用PGm或AVA时，术前TTE显示所有研究患者均为中度或重度AS，而CPB前TEE显示5.4%（n = 92）的患者为轻度AS。