De Simone R, Lange R, Tanzeem A, Gams E, Hagl S
Department of Cardiac Surgery, University of Heidelberg, Germany.
Am J Cardiol. 1993 Apr 15;71(11):926-31. doi: 10.1016/0002-9149(93)90908-u.
Intraoperative transesophageal echocardiography (TEE) can play a major role in active guidance of cardiac surgery. This study describes a new application of TEE for assisting tricuspid suture annuloplasty. Twenty-five patients (aged 52 +/- 11 years) who underwent mitral valve replacement and tricuspid valve annuloplasty were studied intraoperatively by TEE. After cardiopulmonary bypass, the suture annuloplasty was adjusted on the beating heart until palpable regurgitation was eliminated. Further adjustment of the suture was performed under echocardiographic guidance until color Doppler flow imaging showed the most adequate correction of tricuspid regurgitation (TR). A significant decrease in the semiquantitative grade of TR, of regurgitant jet area and of the ratio jet area/right atrial area was obtained when the suture was adjusted under echocardiographic guidance. The peak inflow velocity and the gradient across the tricuspid valve did not show significant changes throughout the procedures. The results showed that the tricuspid suture annuloplasty guided by TEE enables a substantial reduction in residual TR without creating valve stenosis.
术中经食管超声心动图（TEE）在心脏手术的主动引导中可发挥重要作用。本研究描述了TEE在辅助三尖瓣缝线环缩成形术中的一种新应用。对25例（年龄52±11岁）接受二尖瓣置换和三尖瓣环缩成形术的患者在术中进行了TEE研究。体外循环后，在跳动的心脏上调整缝线环缩成形术，直到消除可触及的反流。在超声心动图引导下进一步调整缝线，直到彩色多普勒血流成像显示三尖瓣反流（TR）得到最充分的纠正。当在超声心动图引导下调整缝线时，TR的半定量分级、反流束面积以及反流束面积与右心房面积之比均显著降低。在整个手术过程中，三尖瓣的峰值流入速度和跨瓣压差没有显著变化。结果表明，TEE引导下的三尖瓣缝线环缩成形术能够在不造成瓣膜狭窄的情况下大幅减少残余TR。
