Rosenfeld H M, Gentles T L, Wernovsky G, Laussen P C, Jonas R A, Mayer J E, Colan S D, Sanders S P, van der Velde M E
Department of Cardiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Pediatr Cardiol. 1998 Jul-Aug;19(4):346-51. doi: 10.1007/s002469900319.
To investigate the accuracy of immediate postbypass transesophageal echocardiography in the assessment of residual cardiac defects, we compared intraoperative transesophageal echocardiograms with intra/postoperative data in 86 patients, aged 4 days to 30.7 years (median = 1.4 years), at risk for a total of 174 postoperative lesions: right (n = 55) or left (n = 26) ventricular outflow tract obstruction, ventricular septal defect (n = 65), aortic (n = 12) or mitral regurgitation (n = 8), or mitral stenosis (n = 8). Accuracy of intraoperative transesophageal echocardiography was evaluated based on comparison with (1) immediate post-bypass left (n = 4) or right (n = 9) ventricular outflow tract pressure gradients by pullback in the operating room, (2) direct surgical inspection of residual ventricular septal defects (n = 3), (3) pulmonary artery oxygen saturation (n = 49), (4) right ventricular outflow tract pullback gradient (n = 24), and (5) transthoracic echocardiogram (n = 51) performed within 40 days of surgery. The results indicate that intraoperative transesophageal echocardiography agreed with intra/postoperative data in 87% of patients at risk for right ventricular outflow tract obstruction, 96% at risk for left ventricular outflow tract obstruction, 97% at risk for ventricular septal defect, and 100% at risk for aortic regurgitation, mitral regurgitation, or mitral stenosis. Significant residual lesions led to immediate surgical revision in 11 cases: 3 ventricular septal defects, 6 right and 2 left ventricular outflow tract obstructions. Of these, intraoperative transesophageal echocardiography confirmed and quantified suspected residual lesions in 7 and identified unsuspected lesions in 4 cases. Immediate postbypass transesophageal echocardiography proved reliable for assessing residual ventricular septal defect, mitral stenosis, and mitral or aortic regurgitation. Although accurate for assessment of the left and right ventricular outflow tracts in most patients, transesophageal echocardiography may not reliably reflect the severity of obstruction in all cases.
为研究体外循环后即刻经食管超声心动图在评估残余心脏缺损方面的准确性，我们将86例年龄在4天至30.7岁（中位数=1.4岁）的患者术中经食管超声心动图结果与术中和术后数据进行了比较，这些患者共有174个术后病变风险：右（n=55）或左（n=26）心室流出道梗阻、室间隔缺损（n=65）、主动脉反流（n=12）或二尖瓣反流（n=8），或二尖瓣狭窄（n=8）。术中经食管超声心动图的准确性通过与以下各项比较来评估：（1）在手术室通过回撤法测得的体外循环后即刻左（n=4）或右（n=9）心室流出道压力阶差；（2）对残余室间隔缺损进行的直接手术检查（n=3）；（3）肺动脉血氧饱和度（n=49）；（4）右心室流出道回撤梯度（n=24）；以及（5）在术后40天内进行的经胸超声心动图检查（n=51）。结果表明，术中经食管超声心动图与术中和术后数据的一致性在有右心室流出道梗阻风险的患者中为87%，在有左心室流出道梗阻风险的患者中为96%，在有室间隔缺损风险的患者中为97%，在有主动脉反流、二尖瓣反流或二尖瓣狭窄风险的患者中为100%。11例患者因存在显著残余病变而立即进行了手术修正：3例室间隔缺损、6例右心室流出道梗阻和2例左心室流出道梗阻。其中，术中经食管超声心动图在7例中证实并量化了可疑的残余病变，在4例中发现了未被怀疑的病变。体外循环后即刻经食管超声心动图被证明在评估残余室间隔缺损、二尖瓣狭窄以及二尖瓣或主动脉反流方面是可靠的。虽然经食管超声心动图在大多数患者中对左右心室流出道的评估是准确的，但在所有情况下可能无法可靠地反映梗阻的严重程度。
