Niwa Y, Yoshida K, Akasaka T, Hozumi T, Yamaura Y, Okada Y, Shomura T, Yoshikawa J
Division of Cardiology, Kobe General Hospital.
J Cardiol. 1996 Sep;28(3):155-9.
Mitral valve repair offers many advantages over prosthetic valve replacement, especially in minimizing the risk of thromboembolism. Intraoperative evaluation of residual mitral regurgitation (MR) is important in this procedure. The present study assessed the usefulness of transesophageal echocardiography (TEE) for the intraoperative assessment of residual MR in patients undergoing mitral valve repair. Intraoperative TEE was performed in 102 consecutive patients before and after mitral valve repair in the operating room. The grade of MR was evaluated according to the maximum MR jet area detected by biplane color Doppler TEE (mild: <4 cm2; moderate: 4 < or = < 7 cm2; severe : 7 cm2 < or =). After the first repair, the manual regurgitant test was performed. Excellent results with no or mild MR assessed by the manual regurgitant test were obtained in 101 patients. However, moderate or severe MR was identified in eight of these 101 (7.9%) patients by TEE after weaning from the cardiopulmonary bypass. Consequently, six of these eight patients underwent repeat mitral valve repair and two patients received prosthetic valve replacement. Satisfactory final operative results were obtained in all 101 patients. The eight patients who needed additional operative procedures followed good clinical courses in hospital. TEE 1 month after operation demonstrated no or mild MR in these eight patients. Intraoperative TEE is useful in the evaluation of residual MR after mitral valve repair. This technique provides indications for immediate additional operative procedures, and can reduce the occurrences of congestive heart failure and reoperation in the early stage after mitral valve repair.
二尖瓣修复术与人工瓣膜置换术相比具有诸多优势，尤其是在将血栓栓塞风险降至最低方面。术中评估残余二尖瓣反流（MR）在该手术中至关重要。本研究评估了经食管超声心动图（TEE）在二尖瓣修复术患者术中评估残余MR的实用性。在手术室对102例连续进行二尖瓣修复术的患者在二尖瓣修复前后进行了术中TEE检查。根据双平面彩色多普勒TEE检测到的最大MR射流面积评估MR分级（轻度：<4 cm²；中度：4≤<7 cm²；重度：7 cm²≤）。首次修复后，进行了人工反流试验。101例患者通过人工反流试验评估获得了无或轻度MR的优异结果。然而，在这101例患者中有8例（7.9%）在体外循环脱机后经TEE检查发现中度或重度MR。因此，这8例患者中有6例接受了再次二尖瓣修复术，2例接受了人工瓣膜置换术。所有101例患者均获得了满意的最终手术结果。这8例需要额外手术的患者在医院的临床过程良好。术后1个月的TEE检查显示这8例患者无或轻度MR。术中TEE在评估二尖瓣修复术后的残余MR方面很有用。该技术可为立即进行额外手术提供指征，并可减少二尖瓣修复术后早期充血性心力衰竭和再次手术的发生率。
