Herlong J R, Li J S, Bengur A R, Ungerleider R M
Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Thorac Surg. 1995 Sep;60(3):678-80. doi: 10.1016/0003-4975(95)00309-9.
Intraoperative transesophageal echocardiography provides the surgical team with important guidance during operations for congenital heart disease. Doppler echocardiography adds hemodynamic information to that provided by two-dimensional imaging. Here we describe intraoperative pulmonary vein Doppler echocardiography after operation involving the left atrium.
Intraoperative two-dimensional and pulsed-wave Doppler echocardiography of pulmonary veins were performed after surgical repair of anomalous pulmonary venous return in 4 patients.
In 3 patients, intraoperative pulmonary vein Doppler findings were suggestive of obstruction. The surgical repair was thought to be excellent, and there was no obstruction apparent anatomically or clinically. No further intervention was performed, and all patients recovered uneventfully. No pulmonary venous obstruction was noted on follow-up two-dimensional echocardiography, and follow-up pulmonary vein Doppler echocardiography showed the expected pattern.
An obstructive pattern in the pulmonary vein Doppler was seen in 3 of 4 patients studied immediately after repair of anomalous pulmonary venous return. No obstruction, however, was manifest then or subsequently. The abnormal Doppler pattern, thus, is not indicative of pulmonary venous obstruction. We propose that acute postoperative changes in left atrial volume and compliance and acute postoperative tissue changes in the left atrium explain the abnormal pulmonary vein Doppler patterns observed.
术中经食管超声心动图为先天性心脏病手术团队提供重要指导。多普勒超声心动图为二维成像提供的信息增添了血流动力学信息。在此，我们描述涉及左心房手术术后的术中肺静脉多普勒超声心动图情况。
对4例肺静脉异位引流手术修复后的患者进行术中肺静脉二维和脉冲波多普勒超声心动图检查。
3例患者术中肺静脉多普勒检查结果提示有梗阻。手术修复效果被认为极佳，解剖学或临床上均未发现明显梗阻。未进行进一步干预，所有患者均顺利康复。随访二维超声心动图未发现肺静脉梗阻，随访肺静脉多普勒超声心动图显示为预期模式。
在4例肺静脉异位引流修复术后立即进行研究的患者中，3例出现肺静脉多普勒梗阻模式。然而，当时及随后均未出现梗阻表现。因此，异常多普勒模式并不提示肺静脉梗阻。我们认为，左心房容积和顺应性的急性术后变化以及左心房的急性术后组织变化可解释所观察到的异常肺静脉多普勒模式。
