【摘要】 目的探讨术中经食管超声心动图(IOTEE)在保留主动脉瓣根部手术(David)手术中的应用价值。方法使用IOTEE对35例预施行保留主动脉瓣的根部替换术(David手术)的患者进行研究,其中男24例,女11例,年龄10～64岁,平均(37±15)岁。近端行DavidI型6例;DavidII型26例;阜外医院设计的改良David手术3例。开胸或体外循环前通过IOTEE评价主动脉瓣的结构情况,主动脉瓣的反流程度,瓣环内径,主动脉窦部及升主动脉起始部情况,左室收缩功能。所有的这些患者均适合施行David手术;术毕心脏复跳后通过IOTEE再次评价主动脉瓣,主动脉窦部及升主动脉起始部情况。结果这35例患者均成功施行了David手术。所有患者心功能I级;主动脉瓣无反流13例,轻度反流19例,轻中度反流3例;主动脉窦部内径由术前的(49.5±7.9)mm缩小为术后的(28.6±4.5)mm;升主动脉替换为人工血管,由术前的(42±4.5)mm变为术后的(30±2.8)mm;无需二次手术治疗。结论IOTEE可即刻评价David术的可行性和手术效果。同时David手术也是对主动脉瓣叶及瓣环大致正常的主动脉根部疾病一种较为理想的手术方案。更多还原

【Abstract】 Objective To evaluate the value of the intraoperative transesophageal echocardiography(IOTEE)during the valve-sparing aortic root surgery(David).Methods Totally 35 patients including 24 men and 11 women(age,37±15,mean,10-64 years)with aortic root disease underwent David procedure assessed on IOTEE.Six patients underwent aortic valve-sparing reimplantation procedure(David I),26 patients underwent aortic valve-sparing remodeling(David II),and 3 underwent a new modified aortic valve-sparing operation designed by Fuwai Hospital.The anatomy of aortic valve,degree of the aortic regurgitation,annular diameter,systolic function of the left ventricle,aotic sinus and ascending aorta were all assessed on IOTEE before cardiopulmonary bypass.All the patients were suitable for the David procedures.After the operation,the second assessment of the same contents were followed in all the patients.Results All the procedures were completed successfully.All patients recovered to heart function of class I.After operation,13 patients were normal,9 patients had mild and 3 had mild to moderate aortic regurgitation.The diameter of the aortic sinus was decreased from 49.5±7.9 mm to 28.6±4.5 mm.The ascending aorta were replaced with artificial tube graft,the diameter of which was from 42±4.5 mm to 30±2.8 mm.Conclusions IOTEE provides a practical and valuable technique during David procedure and can evaluate and guide the operation,and may avoid reoperation.In our opinion,David operation and aortic valve-sparing procedure is a more ideal operation strategy for aortic root disease with more or less normal aortic leaflets and valvular rings.更多还原