综合超声心动图在儿童主动脉瓣畸形Ozaki手术中的应用价值研究
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摘要
目的评价经胸二维超声心动图(2DE)、经食道超声心动图(TEE)、经胸三维超声心动图(3DE)在儿童主动脉瓣病变Ozaki手术中的应用价值。方法回顾性分析7例Ozaki手术患者的2DE、TEE、3DE资料特征。结果 7例患者术前均行2DE及3DE检查,与手术结果对比,超声诊断正确7例,占100%;合并单支冠状动脉2例、冠状动脉肺动脉瘘1例,超声检查均漏诊。7例均行术中TEE检查,术后3个月2DE复查,主动脉反流束宽明显减轻(0.64±0.25)cm vs (0.22±0.04)cm,(P<0.01)、左心室舒张末期内径明显减小(5.69±0.45)cm vs (4.50±0.83)cm,(P<0.01)。结论2DE、3DE术前可以显示主动脉瓣的数目、大小、狭窄及反流的程度,比较准确地诊断主动脉瓣病变,但容易漏诊合并的冠状动脉畸形;TEE在术中即刻效果判断、2DE在术后随访中起重要作用,是儿童主动脉瓣病变Ozaki手术安全、有效的监测方法。
Objective To evaluate the value of integrated echocardiography in Ozaki operation in children with aortic valve malformation. Methods Ozaki operation was performed in 7 children with aortic valve malformation. Transthoracic 2-dimensional echocardiography(2 DE), Transthoracic 3-dimensional echocardiography(3 DE) and transesophageal echocardiography(TEE) were performed before and after Ozaki operation. Results Compared with the surgical findings, aortic valve malformation was diagnosed correctly in 7 cases(100%) by 2 DE and 3 DE, 2 cases with single coronary artery and 1 case with fistula between coronary artery and pulmonary artery were miss diagnosed. TEE and 2 DE were performed during and 3 months later of Ozaki operation, vena contracta width of aortic valve regurgitation was reduced significantly(0.64±0.25) cm vs(0.22±0.04) cm,(P<0.01). Conclusion Integrated echocardiography could clearly demonstrate the number, size of aortic valve anomalies. It was valuable for patients selection before the operation, and evaluating the operative effects and was a safe and effective guidance technique. It was prone to be miss diagnosed for associated coronary artery anomaly.
Objective To evaluate the value of integrated echocardiography in Ozaki operation in children with aortic valve malformation. Methods Ozaki operation was performed in 7 children with aortic valve malformation. Transthoracic 2-dimensional echocardiography(2 DE), Transthoracic 3-dimensional echocardiography(3 DE) and transesophageal echocardiography(TEE) were performed before and after Ozaki operation. Results Compared with the surgical findings, aortic valve malformation was diagnosed correctly in 7 cases(100%) by 2 DE and 3 DE, 2 cases with single coronary artery and 1 case with fistula between coronary artery and pulmonary artery were miss diagnosed. TEE and 2 DE were performed during and 3 months later of Ozaki operation, vena contracta width of aortic valve regurgitation was reduced significantly(0.64±0.25) cm vs(0.22±0.04) cm,(P<0.01). Conclusion Integrated echocardiography could clearly demonstrate the number, size of aortic valve anomalies. It was valuable for patients selection before the operation, and evaluating the operative effects and was a safe and effective guidance technique. It was prone to be miss diagnosed for associated coronary artery anomaly.
引文
[1] Yamashita H, Ozaki S. Valvular heart disease: current treatment and future perspectives. Topics: III. Current treatment: surgical vs. medical; aortic valve, surgical treatment for aortic valve disease[J]. Nihon Naika Gakkai Zasshi. 2016,105(2):206-214.
[2] 冯娟,延良海,王锡明,等.主动脉瓣病变的影像学研究进展[J].医学影像学杂志,2014,24(10):1838-1841.
[3] 罗开琴.经胸超声心动图对先天性二叶式主动脉瓣畸形的诊断价值[J].医学影像学杂志,2012,22(2):280-281.
[4] Ozaki S, Kawase I, Yamashita H, et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium [J]. J Thorac Cardiovasc Surg, 2014, 147(1): 301-306.
[5] Ozaki S, Kawase I, Yamashita H, et al. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease [J]. Interact Cardiovasc Thorac Surg, 2011, 12(4): 550-553.
[6] Ozaki S, Kawase I, Yamashita H, et al. Reconstruction of bicuspid aortic valve with autologous pericardium-usefulness of tricuspidization [J]. Circ J, 2014, 78(5): 1144-1151.
[7] Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the american society of echocardiography pediatric and congenital heart disease council [J]. J Am Soc Echocardiogr, 2010, 23(5): 465-495.
[8] Ma K, Li S, Hu S, et al. Neoaortic valve regurgitation after arterial switch: ten years outcomes from a single center [J]. Ann Thorac Surg, 2016, 102(2): 636-642.
[9] Meuris B, Ozaki S, Neethling W, et al. Trileaflet aortic valve reconstruction with a decellularized pericardial patch in a sheep model [J]. J Thorac Cardiovasc Surg, 2016, 152(4): 1167-1174.
[10] 洪雯静,张玉奇,钟玉敏,等.先天性左冠状动脉闭锁的超声心动图诊断价值[J].医学影像学杂志,2017,27(4):625-628.
[2] 冯娟,延良海,王锡明,等.主动脉瓣病变的影像学研究进展[J].医学影像学杂志,2014,24(10):1838-1841.
[3] 罗开琴.经胸超声心动图对先天性二叶式主动脉瓣畸形的诊断价值[J].医学影像学杂志,2012,22(2):280-281.
[4] Ozaki S, Kawase I, Yamashita H, et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium [J]. J Thorac Cardiovasc Surg, 2014, 147(1): 301-306.
[5] Ozaki S, Kawase I, Yamashita H, et al. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease [J]. Interact Cardiovasc Thorac Surg, 2011, 12(4): 550-553.
[6] Ozaki S, Kawase I, Yamashita H, et al. Reconstruction of bicuspid aortic valve with autologous pericardium-usefulness of tricuspidization [J]. Circ J, 2014, 78(5): 1144-1151.
[7] Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the american society of echocardiography pediatric and congenital heart disease council [J]. J Am Soc Echocardiogr, 2010, 23(5): 465-495.
[8] Ma K, Li S, Hu S, et al. Neoaortic valve regurgitation after arterial switch: ten years outcomes from a single center [J]. Ann Thorac Surg, 2016, 102(2): 636-642.
[9] Meuris B, Ozaki S, Neethling W, et al. Trileaflet aortic valve reconstruction with a decellularized pericardial patch in a sheep model [J]. J Thorac Cardiovasc Surg, 2016, 152(4): 1167-1174.
[10] 洪雯静,张玉奇,钟玉敏,等.先天性左冠状动脉闭锁的超声心动图诊断价值[J].医学影像学杂志,2017,27(4):625-628.