Bach D S, Deeb G M, Bolling S F
Department of Internal Medicine, University of Michigan, Ann Arbor 48109, USA.
Am J Cardiol. 1995 Sep 1;76(7):508-12. doi: 10.1016/s0002-9149(99)80140-4.
Although intraoperative transesophageal echocardiography (TEE) is used to guide mitral valve reconstructive procedures, the effects of hemodynamic alterations accompanying general anesthesia on mitral regurgitation (MR) are unknown. This study was performed to evaluate the effect of general anesthesia on MR jet size using TEE with color Doppler imaging in patients undergoing mitral valve surgery. Matched preoperative TEEs performed with the patient under intravenous conscious sedation, and intraoperative studies performed with the patient under general anesthesia were retrospectively reviewed in 46 patients undergoing mitral valve surgery. Patients were divided into groups based on etiology of MR, including 21 patients with myxomatous degeneration and leaflet flail, 19 patients with structurally normal leaflets and functional regurgitation due to abnormal leaflet coaptation, and 6 patients with rheumatic mitral disease. On both preoperative and intraoperative studies, regurgitation was quantified using maximal jet area and jet diameter at the vena contracta on color flow Doppler. Patients with leaflet flail and patients with functional MR had similar measures of regurgitation severity on preoperative imaging. On intraoperative imaging, regurgitant jet size was unchanged compared with preoperative studies among patients with leaflet flail (jet diameter 1.04 +/- 0.26 vs 1.10 +/- 0.28 cm, area 9.8 +/- 4.5 vs 10.1 +/- 5.2 cm2 on preoperative studies), although jet size decreased significantly in patients with functional MR (jet diameter 0.79 +/- 0.33 vs 1.10 +/- 0.29 cm [p < 0.001], area 5.7 +/- 3.5 vs 10.0 +/- 3.8 cm2 [p < 0.001] on preoperative studies). These findings were not accounted for by variation in heart rate, blood pressures, echocardiographic instrumentation, or Doppler Nyquist limit.(ABSTRACT TRUNCATED AT 250 WORDS)
尽管术中经食管超声心动图（TEE）用于指导二尖瓣重建手术，但全身麻醉伴随的血流动力学改变对二尖瓣反流（MR）的影响尚不清楚。本研究旨在使用TEE彩色多普勒成像评估全身麻醉对二尖瓣手术患者MR喷射大小的影响。对46例接受二尖瓣手术的患者进行回顾性分析，这些患者术前在静脉镇静下进行了匹配的TEE检查，术中在全身麻醉下进行了研究。根据MR病因将患者分组，包括21例黏液瘤样变性和瓣叶连枷患者、19例瓣叶结构正常但因瓣叶对合异常导致功能性反流的患者以及6例风湿性二尖瓣疾病患者。在术前和术中研究中，使用彩色血流多普勒在收缩期测量反流的最大喷射面积和喷射直径以对反流进行量化。瓣叶连枷患者和功能性MR患者在术前成像时反流严重程度的测量结果相似。在术中成像时，瓣叶连枷患者的反流喷射大小与术前研究相比无变化（术前研究中喷射直径为1.04±0.26 vs 1.10±0.28 cm，面积为9.8±4.5 vs 10.1±5.2 cm²），而功能性MR患者的喷射大小显著减小（术前研究中喷射直径为0.79±0.33 vs 1.10±0.29 cm [p<0.001]，面积为5.7±3.5 vs 10.0±3.8 cm² [p<0.001]）。这些发现不能用心率、血压、超声心动图仪器或多普勒奈奎斯特极限的变化来解释。（摘要截断于250字）
