Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI, 02903, USA.
, East Greenwich, USA.
BMC Anesthesiol. 2022 Oct 24;22(1):326. doi: 10.1186/s12871-022-01873-5.
Transesophageal echocardiographic imaging plays an important role in assessing coronary sinus anatomy prior to placement of a retrograde cardioplegia cannula. The coronary sinus can be imaged in the long axis by advancing the TEE probe from the mid-esophageal 4-chamber view or using a modified mid-esophageal bicaval view, while a short axis view can be obtained in the mid-esophageal 2-chamber view. While use of a transgastric view is only briefly mentioned in the literature as an alternative to mid-esophageal views, the authors commonly include it in our comprehensive transesophageal echocardiographic exam of the coronary sinus. This study examines the various imaging strategies. We hypothesize that the transgastric view offers comparable coronary sinus imaging to the mid-esophageal views.
After approval by our institutional review board, the intraoperative transesophageal echocardiographic exams for 50 consecutive elective cardiac surgical patients with a comprehensive echocardiographic assessment of the coronary sinus were retrospectively reviewed and analyzed to evaluate imaging of the coronary sinus in the various views. For each view, we noted and recorded if the coronary sinus and coronary sinus cannula were visualized. Statistical analysis required pairwise comparisons between each of the 4 views. P values were calculated using McNemar's Exact test.
Both the coronary sinus and coronary sinus cannula were visualized a majority of the time for each view. There was no statistically significant difference between each view in its ability to visualize the coronary sinus, nor was there a statistically significant difference between each view in its ability to visualize the coronary sinus cannula.
Use of a transgastric window provides the echocardiographer with an effective alternate modality for imaging the coronary sinus when mid-esophageal views are limited.
经食管超声心动图成像在放置逆行冠状窦灌流管之前对冠状窦解剖结构的评估中发挥着重要作用。冠状窦可以通过从食管中段 4 腔心视图推进 TEE 探头或使用改良的食管中段双腔静脉视图在长轴上进行成像，而短轴视图可以在食管中段 2 腔心视图中获得。虽然在文献中仅简要提到了经胃视图作为食管中段视图的替代方法，但作者通常将其包含在我们对冠状窦的全面经食管超声心动图检查中。本研究探讨了各种成像策略。我们假设经胃视图提供了与食管中段视图相当的冠状窦成像。
在获得我们机构审查委员会的批准后，回顾性分析了 50 例连续接受择期心脏手术的患者的术中经食管超声心动图检查，对冠状窦进行全面超声心动图评估，以评估各种视图下的冠状窦成像。对于每一个视图，我们注意并记录了冠状窦和冠状窦插管是否可见。统计分析需要对 4 个视图中的每一个进行两两比较。使用 McNemar 精确检验计算 P 值。
对于每一个视图，冠状窦和冠状窦插管大多数时候都可以被看到。在能够观察到冠状窦的能力方面，每个视图之间没有统计学上的显著差异，也没有在能够观察到冠状窦插管的能力方面存在统计学上的显著差异。
当食管中段视图受到限制时，使用经胃窗为超声心动图医师提供了一种有效的替代方法来对冠状窦进行成像。
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