经食道超声心动图在二尖瓣成形术中的应用(1)
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【摘要】目的：评价经食道超声心动图(TEE)在二尖瓣瓣膜成形术中的应用价值。方法：选择二尖瓣脱垂并伴有中度以上的反流拟行二尖瓣成形术患者21例。术中应用经食道超声心动图评价二尖瓣病变部位，二尖瓣的解剖定位采用Carpentier命名法，将前叶分为A1、A2及A3，后叶分为P1、P2及P3，与术中所见进行对照，术后即刻评价成形效果。结果：本组21例共30处病变部位，28处病变部位与术中所见相符，2处为TEE未发现。18例1次性手术实施成功，2例术中监测发现反流2级，再次行成形术，最终获成功，1例术中监测发现反流3级，改行二尖瓣人工瓣置换术。结论：经食道超声心动图在二尖瓣成形术中判断病变部位、术后即刻评价成形效果具有重要的临床应用价值。
【关键词】二尖瓣关闭不全；二尖瓣成形术；经食道超声心动图
Application of Transoesophageal Echocardiography in the Mitral Valvuloplasty/YUE Qing-xiong.//Medical Innovation of China，2012，9(11):078-079
【Abstract】Objective:To evaluate the value of transoesophageal echocardiography(TEE) in the mitral valvuloplasty.Methods:Twenty-one consecutive mitral valve (MV) prolapse patients with more than moderate mitral regurgitation (MR) referred for mitral valvuloplasty were studied.All the patients underwent TEE study to evaluate the location of scallop lesions for MV，and compared with surgical findings.The Carpentier nomenclature was applied to the mitral valve leaflets，three posterior leaflet scallops defined as lateral(P1)，middle(P2)，medial(P3)，and three anterior leaflet scallops defined as lateral(A1)，middle(A2)，medial(A3).TEE was performed to evaluate the effect of the mitral valvuloplasty.Results:28 of 30 location of scallop lesions were found by TEE，and 2 were not found in 21 patients.18 surgical operations were successful in one time in 21 patients.MR grade 2 were found by TEE after operation in 2 patients.They underwent mitral valvuloplasty again and successed.MR grade 3 were found by TEE after operation in 1 patient，then mitral valve replacement was taked.Conclusion:TEE has high value in evaluating the location of scallop lesions and the effects of the mitral valvuloplasty immediately.
【Key words】Mitral regurgitation；Mitral valvuloplasty；Transoesophageal echocardiography
First-author’s address:Dalian Central Hospital，Dalian 116033，China
doi：10.3969/j.issn.1674-4985.2012.11.049
近年来，对于二尖瓣脱垂病变，外科医生更多的采用瓣膜成形术取代瓣膜置换术。术中对瓣膜病变部位的准确判断以及术后即刻评价成形效果，决定了手术成功率。经食道超声心动图(TEE)在心脏手术中不影响手术视野，不受胸廓干扰，图像清晰，为二尖瓣瓣膜成形术术中判断及监测提供了既简单又可靠的方法。
1资料与方法
1.1一般资料选取2008年3月-2011年12月二尖瓣脱垂伴有中度以上的反流拟行外科手术治疗的患者21例 ......
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