D'Ambra M
Department of Anesthesiology, Massachusetts General Hospital, Boston 02114.
Ann Thorac Surg. 1993 Nov;56(5 Suppl):S83-5. doi: 10.1016/0003-4975(93)91141-9.
Few cardiac surgeons or anesthesiologists would argue with the view that intraoperative echocardiography, both transesophageal and epicardial, has become an important diagnostic tool. Specific diagnostic applications primarily involve valve reconstruction and replacement, as well as complex congenital heart disease repairs. Routine echocardiographic monitoring in cardiac operations is, however, controversial. Three specific modalities may benefit from this technology. Aortic root scanning before cannulation/proximal coronary anastomoses using surface echocardiography is one. Areas with significant atherosclerosis can be identified and manipulation avoided. Another is quantification of global left-ventricular function using transesophageal echocardiography. This method may have specific relevance to patients requiring mechanical circulatory assistance. Using echocardiography to monitor ischemic regional wall-motion abnormalities and using the findings to predict an unfavorable outcome is a third suggested use for perioperative monitoring in cardiac surgery.
术中经食管和心外膜超声心动图已成为一种重要的诊断工具。其具体的诊断应用主要涉及瓣膜重建和置换，以及复杂先天性心脏病的修复。然而，心脏手术中的常规超声心动图监测存在争议。有三种特定的方式可能会受益于这项技术。一种是在插管/近端冠状动脉吻合术前使用体表超声心动图对主动脉根部进行扫描。可以识别出有明显动脉粥样硬化的区域并避免操作。另一种是使用经食管超声心动图对左心室整体功能进行量化。这种方法可能与需要机械循环辅助的患者具有特定相关性。利用超声心动图监测局部缺血性室壁运动异常并将结果用于预测不良结局是心脏手术围手术期监测的第三种建议用途。
