上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

经食道超声心动图在运用腔静脉内阻断技术实施微创三尖瓣再次手术中的应用

姜兆磊1，梅 举1，吴淑彬1，张韫佼1，尹 航1，沈赛娥2   

  1. 上海交通大学 医学院附属新华医院 1.心胸外科， 2.麻醉科， 上海 200092
  • 出版日期:2014-02-28 发布日期:2014-03-25
  • 通讯作者: 沈赛娥, 电子信箱: ej8710@sina.com。
  • 作者简介:姜兆磊（1987—）， 男， 博士生; 电子信箱: wojiangzhaolei@163.com。
  • 基金资助:

    国家临床重点专科项目；上海市科委基金（13XD1403200）；上海交通大学医学院基金（09XJ078）

The role of intraoperative transesophageal echocardiography in minimally invasive reoperative tricuspidal surgery by applying intraluminal occlusion for both caval veins

JIANG Zhao-lei1, MEI Ju1, WU Shu-bin1, ZHANG Yun-jiao1, YIN Hang1, SHEN Sai-e2   

  1. 1.Department of Cardiothoracic Surgery, 2.Department of Anesthesiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2014-02-28 Published:2014-03-25
  • Supported by:

    National Clinical Key Specialty Construction Project； Science and Technology Commission of Shanghai Municipality Foundation，13XD1403200; Shanghai Jiao Tong University School of Medicine Foundation, 09XJ078

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摘要：

目的 探讨经食道超声心动图（TEE）在运用腔静脉内阻断技术实施微创三尖瓣再次手术中的应用价值。方法 2002年12月—2012年6月，经右胸前外侧切口，运用腔静脉腔内阻断技术在体外循环心脏不停跳下实施微创三尖瓣再次手术46例，其中男性27例，女性19例；年龄13~67岁。术中运用TEE全程监测配合整个手术，主要包括指导和评价腔静脉插管的位置、球囊阻断效果，以及评估术前、术后瓣膜反流及心功能情况。结果 在TEE引导下运用腔静脉内阻断技术，46例患者均顺利实施了微创三尖瓣再次手术。在建立体外循环时，所有患者上、下腔静脉插管顺利，无再次插管病例；有2例患者TEE显示腔静脉首次阻断不完全，在TEE指引下重新调整插管球囊的位置和大小至阻断完全。46例患者平均手术时间（161±52）min，平均建立体外循环时间（手术开始至体外循环开始时间）（55±15）min，平均体外循环时间（58±23）min。术中TEE显示所有患者三尖瓣启闭功能良好，无明显残余反流，无瓣周漏。全组患者均成功治愈出院。结论 运用腔静脉内阻断技术实施微创三尖瓣再次手术时，TEE可安全、可靠地引导和监测手术，具有重要的临床应用价值。

关键词: 经食道超声心动图, 腔内阻断, 三尖瓣手术, 再次, 微创外科手术

Abstract:

Objective To explore the value of intraoperative transesophageal echocardiography (TEE) in minimally invasive reoperative tricuspidal surgery by applying intraluminal occlusion for both caval veins. Methods From December 2002 to June 2012, 46 consecutive reoperative tricuspid valve operations were performed through a minimally invasive approach in the right fourth intercostal space without aortic cross-clamping, including 27 males and 19 females with ages between 13~67 years. TEE was used for monitoring and cooperation during the course of operations, estimating the degree of the TR, and guiding the occlusion of superior vena cava (SVC) and the inferior vena cava (IVC). Results All 46 patients underwent minimally invasive reoperative tricuspidal surgery successfully under the guidance of TEE. There were no cardiopulmonary bypass accidents during operations. The position and size of the balloons of two patients were readjusted to block caval veins completely under the guidance of TEE. The average time of operation was (161±52) min. The average time of building cardiopulmonary bypass (CPB) was (55±15) min and the average time of CPB was (58±23) min. TEE showed that all patients had no tricuspid incompetence during operations. Paravalvular leakage did not occur in tricuspid valve replacement (TVR).  All patients were successfully treated and discharged. Conclusion TEE can safely and reliably guide and monitor the operation when performing minimally invasive repeated isolated tricuspid valve surgery with vena cava intraluminal occlusion technique. Hence it has important application value.

Key words: transesophageal echocardiography, intraluminal occlusion, tricuspid valve surgery, repeated, minimally invasive surgery