Ozturk Erkut, Cansaran Tanidir Ibrahim, Ayyildiz Pelin, Gokalp Selman, Candas Kafali Hasan, Sahin Murat, Ergul Yakup, Haydin Sertac, Guzeltas Alper
Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey.
Gelisim Universitesi, Istanbul, Turkey.
Echocardiography. 2018 Jul;35(7):999-1004. doi: 10.1111/echo.13874. Epub 2018 Mar 25.
Our aim was to evaluate the findings and the role of intraoperative epicardial echocardiography (IEE) in the management of pediatric cardiac surgery patients.
Patients evaluated with IEE between December 2015 and December 2017 were analyzed retrospectively. Demographic data, preoperative transthoracic echocardiography (TTE), and IEE reports were evaluated.
A total of 410 patients evaluated by IEE were included in the study. Of these, 52% were women, and 48% were men. The median age was 8.5 months (range: 1 month-7 years), and median body weight was 7.1 kg (range: 3.3-61 kg). The most common diagnoses were tetralogy of Fallot (TOF; n = 148), ventricular septal defect (VSD; n = 117), atrial septal defect (ASD; n = 57), and complete atrioventricular septal defect (AVSD; n = 48). There were minor residual lesions not requiring reestablishment of cardiopulmonary bypass (CPB) in 16.6% (n = 68), while major residual lesions requiring return to CPB were determined in 5.1% (n = 21). Major residual lesions were detected in 7 patients with TOF (4 severe right ventricular outflow tract obstructions, 2 pulmonary artery stenosis, 1 residual VSD shunt), 6 patients with VSD (hemodynamically significant residual shunts), and 5 patients with complete AVSD (3 left atrioventricular valve regurgitations, 1 right atrioventricular valve regurgitation, 1 left ventricular outflow tract obstruction). Transient bradycardia was observed in 5 patients.
Intraoperative epicardial echocardiography provides good guidance during congenital heart surgery. IEE helps to clarify the surgical planning and decreases morbidity and mortality due to unnecessary invasive procedures, especially for pathologies involving the pulmonary artery and its branches, as well as for apical ventricular septal defects.
我们的目的是评估术中心外膜超声心动图（IEE）在小儿心脏手术患者管理中的发现及作用。
回顾性分析2015年12月至2017年12月期间接受IEE评估的患者。评估人口统计学数据、术前经胸超声心动图（TTE）和IEE报告。
共有410例接受IEE评估的患者纳入研究。其中，52%为女性，48%为男性。中位年龄为8.5个月（范围：1个月至7岁），中位体重为7.1 kg（范围：3.3至61 kg）。最常见的诊断为法洛四联症（TOF；n = 148）、室间隔缺损（VSD；n = 117）、房间隔缺损（ASD；n = 57）和完全性房室间隔缺损（AVSD；n = 48）。16.6%（n = 68）的患者存在无需重新建立体外循环（CPB）的轻微残余病变，而5.1%（n = 21）的患者确定存在需要返回CPB的主要残余病变。在7例TOF患者中检测到主要残余病变（4例严重右心室流出道梗阻、2例肺动脉狭窄、1例残余VSD分流），6例VSD患者（血流动力学显著的残余分流），以及5例完全性AVSD患者（3例左房室瓣反流、1例右房室瓣反流、1例左心室流出道梗阻）。5例患者观察到短暂性心动过缓。
术中的心外膜超声心动图在先天性心脏手术中提供了良好的指导。IEE有助于明确手术规划，并降低因不必要的侵入性操作导致的发病率和死亡率，特别是对于涉及肺动脉及其分支的病变以及心尖室间隔缺损。
