Siegel L C, St Goar F G, Stevens J H, Pompili M F, Burdon T A, Reitz B A, Peters W S
Department of Anesthesia, Stanford University School of Medicine, Calif, USA.
Circulation. 1997 Jul 15;96(2):562-8. doi: 10.1161/01.cir.96.2.562.
A method for monitoring patients was evaluated in a clinical trial of minimally invasive port-access cardiac surgery with closed chest endovascular cardiopulmonary bypass.
Cardiopulmonary bypass was conducted in 25 patients through femoral cannulas. An endovascular pulmonary artery vent was placed in the main pulmonary artery through a jugular vein. For mitral valve surgery, a catheter was placed in the coronary sinus for delivery of cardioplegia. A balloon catheter ("endoaortic clamp," EAC) used for occlusion of the ascending aorta, delivery of cardioplegia, aortic root venting, and pressure measurement was inserted through a femoral artery and initially positioned by use of fluoroscopy and transesophageal echocardiography (TEE). Potential migration of the EAC was monitored by (1) TEE of the ascending aorta, (2) pulsed-wave Doppler of the right carotid artery, (3) balloon pressure, (4) comparison of aortic root pressure and right radial artery pressure, and (5) fluoroscopy. TEE, fluoroscopy, and pressure measurement were effective in monitoring catheter insertion and position. With inadequate balloon inflation, migration of the EAC toward the aortic valve could be detected with TEE. During administration of cardioplegia, TEE showed movement of the balloon away from the aortic valve, and migration into the aortic arch was detectable with loss of carotid Doppler flow. Stability of EAC position was demonstrated with appropriate balloon volume. Cardioplegic solution was visualized in the aortic root, and aortic root pressure changed appropriately during administration of cardioplegia. Venous cannula position was optimized with TEE and endopulmonary vent flow measurement.
An effective method has been developed for monitoring patients and the catheter system during port-access cardiac surgery.
在一项采用闭式胸腔内血管体外循环的微创端口入路心脏手术临床试验中，对一种患者监测方法进行了评估。
25例患者通过股动静脉插管建立体外循环。经颈静脉在主肺动脉置入一根血管内肺动脉排气导管。对于二尖瓣手术，在冠状窦置入一根导管用于输送心脏停搏液。一根用于阻断升主动脉、输送心脏停搏液、主动脉根部排气和压力测量的球囊导管（“主动脉内阻断钳”，EAC）经股动脉插入，最初通过荧光透视和经食管超声心动图（TEE）定位。通过以下方式监测EAC的潜在移位：（1）对升主动脉进行TEE检查；（2）右颈动脉脉冲波多普勒检查；（3）球囊压力监测；（4）比较主动脉根部压力和右桡动脉压力；（5）荧光透视检查。TEE、荧光透视检查和压力测量在监测导管插入和位置方面是有效的。当球囊充气不足时，通过TEE可检测到EAC向主动脉瓣移位。在输注心脏停搏液期间，TEE显示球囊远离主动脉瓣移动，并且当颈动脉多普勒血流消失时可检测到其移入主动脉弓。适当的球囊容积可确保EAC位置稳定。心脏停搏液在主动脉根部可见，并且在输注心脏停搏液期间主动脉根部压力有适当变化。通过TEE和肺内排气流量测量优化了静脉插管位置。
已开发出一种在端口入路心脏手术期间监测患者和导管系统的有效方法。
