术中组织多普勒成像在左心功能监测中的作用
|
摘要
背景：左室功能是预测心脏病患者转归的重要指标，早期发现和及时处理对患者的转归和预后有明显影响。组织超声多普勒成像(tissue Doppler imaging，TDI)，是一项新的无创定量心肌运动分析技术，可显示心肌收缩、舒张运动频谱，评价心脏功能，它在术中与肺动脉导管监测的心功能及血流动力学参数相关关系尚未见报道，有必要利用经食管超声心动图(TEE)评价TDI在心功能和血流动力学作用。
目的：探索IDT在心脏不同部位的频谱特征及采样成功率；分析TDI参数与肺动脉导管参数的相关性；评价TDI参数在心功能评价中的作用。
方法：冠状动脉旁路移植术患者40例，平均年龄63±7.8岁，窦性心律。同时进行TEE和肺动脉导管监测。肺动脉导管可持续监测心输出量(CO)，中心静脉压(CVP)和肺毛细血管嵌压(PCWP)。用TEE测量和评估患者射血分数(EF)，分别采集常规的二尖瓣(E、A)、左上肺静脉血流频谱(S、D)和TDI频谱(Sa，Ea，Aa)，同时记录肺动脉导管参数，分别将EF、TDI的心肌收缩速度Sa与CO，血流、TDI频谱参数与PCWP进行相关分析；另外，将患者按照心功能指标CI分组，对上述参数再进行相关分析，探讨TDI参数对不同心功能患者的评价作用；对相关良好的参数做出ROC曲线，进行比较找出TDI评价心功能的最佳参数。
结果：1．TEE采集心肌TDI频谱可显示心动周期内心肌收缩，舒张运动的方向、速度等信息，术中常用的采样点中，二尖瓣环室间隔和左室前、下壁采样成功率为(100％)，二尖瓣环侧壁采样成功率相对较低(95％)；采集二尖瓣血流频谱成功率100％；左上肺静脉成功率为85％。
2．心功能较好患者二尖瓣环收缩速度S_(侧壁)、S_(间隔)显著大于心功能较差的患者，S_(间隔)、S_(侧壁)与CO相关良好(r分别为0.606及0.438，P＜0.01)；S_(间隔)与CO在心功能较差的患者有良好相关性(r=0.653，P＜0.01)；目测EF及测量EF均与CO有良好的相关良好(r分别为0.626，0.627，P＜0.01)。
3血流频谱：二尖瓣瓣口血流速度E／A比值与PCWP相关分析中，心功能较差的患者((r=0.621，P＜0.01))比整体(r=0.377，P＜0.05)和心功能正常患者相关性好，肺静脉血流频谱与PCWP未发现相关关系
TDI频谱中：二尖瓣环舒张早期与晚期速度比Ea／Aa_(间隔)(r=—0.635，P＜0.01)、Ea／Aa_(侧壁)(r=-670，P＜0.01)与PCWP呈反相关且相关良好，其中Ea／Aa_(间隔)与PCWP相关性在不同心功能的患者(r分别为-0.802和-0.745)均有稳定的相关关系；结合参数：舒张早期二尖瓣血流速度与二尖瓣环运动速度比值E／Ea_(间隔)(r=0.699，P＜0.01)、E／Ea_(平均)(r=0.685，P＜0.01)、E／Ea_(侧壁)(r=0.681，P＜0.01)与PCWP呈正相关且相关良好，其中E／Ea_(间隔)(r分别为0.681 vs 0.738)和E／Ea_(平均)(r分别为0.760 vs 0.527，)在不同心功能患者与PCWP均有良好的相关关系，其余各参数均与PCWP无相关关系；
对有相关性参数以PCWP＞12mmHg为标准做ROC曲线分析：在综合比较各相关参数ROC曲线下面积可见E／Ea_(间隔)的曲线下面积＞Ea／Aa_(间隔)曲线下面积＞其他参数，血流频谱E／A比值得95％CI包含0.5，不能预测PCWP。确定E／Ea_(间隔)截断点为l4时，E／Ea_(间隔)预测PCWP＞12mmHg的敏感性为83.33-92.31％，特异性为71.43-87.50％；Ea／Aa_(间隔)截断点为0.95时，Ea／Aa_(间隔)预测PCWP＞12mmHg的敏感性60.00-69.23％，特异性为57.14-87.50％。
结论：1 TDI(?)采集心肌TDI频谱可显示心动周期内的心肌收缩，舒张运动的方向、速度等信息，术中常用的采样点中，二尖瓣环室间隔和左室前壁采样成功率高(100％)，二尖瓣环侧壁采样成功率相对较低(95％)；采集二尖瓣血流频谱成功率较高(100％)；左上肺静脉血流频谱成功率相对较低(85％)。
2术中TEE测量和目测EF可以快速准确地评价左室收缩功能；二尖瓣环间隔、侧壁心肌收缩速度，特别是间隔侧可反映左室收缩功能；左室前、后壁心肌收缩速度不能反映左室收缩功能。
3二尖瓣口血流频谱虽然与PCWP有相关关系，但并不能预测PCWP的升高，TDI频谱中血流速度和组织运动结合参数E／Ea_(间隔)预测左室舒张功能最好，其次为TDI参数Ea／Aa_(间隔)。
Background: Cardiac function is good predictor of outcome for cardiac surgery patients. Fast assessment and early intervention of left ventricular (LV) function provides an important information on the hemodynamic status and benefits the outcome and prognosis in the cardiac surgery patients. TDI(tissue Doppler imaging) is a new noninvasive technology of assessing movement of myocardium, which is used for evaluation of the cardiac function. However, there is no literatures on correlation between the TDI variables and pulmonary arterial catheter parameters(PAC) reported in cardiac surgery patients. This study is designed to analysis the relationship between the TDI variables and PAC parameters.
Objects: This study was to investigate the success rate of TDI and conventional Doppler sampling at different site of heart; to assess whether mitral annular velocities as measured by TDI are associated with invasive measures of PAC parameters and whether additional information is gained over traditional Doppler variables; to investigate the reliability of TDI in estimating left ventricular filling pressure.
Methods: We prospectively studied 40 patients, mean age 63±7.8 years, in sinus rhythm. All patients underwent CABG. Transesophageal echocardiography (TEE), pulmonary artery catheterization (PAC) and other hemodynamic monitoring were performed at the same time. PAC investigated continuous cardiac output (CCO), central venous pressure(CVP) and pulmonary capillary wedged pressure(PCWP). TEE-LVEF was calculated using M-mode analysis and vision assessment of wall motion of LV wall. The following Doppler parameters were assessed: PW Doppler signals from the mitral inflow (E, A), PW TDI of the mitral annulus (Sa, Ea, Aa), thus allowing to obtain the mitral inflow to annulus ratio (E/Ea). Correlations were analyzed between EFs、Sa and CO, and between the TDI parameters and PCWP. Then according to the CI＞2.0, patients were divided into 2 subgroups. Correlations were re-analyzed in the subgroups to identify the differences between two groups. ROC analysis was done for the correlated variables to identify the best parameter and cut-off value to predict elevation of PCWP.
Results: 1 TDI spectrums could be obtained from septal annulus, lateral annulus, anterior wall and posterior wall of left ventricle. The success rate of sampling from septal annulus, anterior and posterior wall is 100%, while the lateral annulus is 95%(2 cases unsuccessful). Mitral signal is more easly got with success rate of 100% than pulmonary venous signals with success rate of 85%.
2. For the systolic function, both annulus contraction velocity in septal and lateral wall are significantly higher(4.7±0.8, and 6.2±2.2) in normal function group than that(3.8±0.763.8±0.76 and 4.5±1.0) in abnormal group(P＜0.05); Septal and lateral contraction velocity correlated well with CO (r=0.606 and 0.438 respectively), and septal contraction velocity correlated with CO in abnormal group(r=0.653, P＜0.01). Both EFs investigated by calculation(r=0.627, P＜0.01) and vision assessment(r=0.626, P＜0.01) correlate well with CO as well.
3. Diastolic function: Although transmitral E/A ratio showed a better correlation with PCWP in abnormal group than that in whole patients, ROC analysis showed that it could not predict the PCWP elevation because 0.5 was included in 95% CI. Pulmonary venous velocity curves were not found have close relationship with PCWP in this study. For TDI of mitral annulus movements, early and late velocity ratio(Ea/Aa) at septal and lateral wall show an inverse correlation with PCWP(r=-0.635, and -0.670 respectively). Septal annulus Ea/Aa has a constant relationship with both normal and abnormal group(r=-0.635 and -0.670 repectively). The ratio of mitral velocity to early diastolic velocity of septal mitral annulus E/Ea(r=0.699, P＜0.01), mean E/Ea(r=0.685, P＜0.01)、lateral E/Ea (r=0.681, P＜0.01) ) showed a correlation with PCWP, and septal E/Ea间隔(r=0.681vs 0.738), mean E/Ea (r=0.760 vs 0.527,) had better correlation than did other Doppler variables for all levels of systolic function. The ROC analysis was repeated with PCWP＞12 mm Hg used as the definition of elevated filling pressure. The areas under the respective ROC curves were 0.905(septal E/Ea), 0.764(setal Ea/Aa), 0.732 (mean E/Ea ratio).
As with the cutoff value of E/Ea＞14 mm Hg, the septal E/Ea and lateral Ea/Aa had the best ROC curve and was the most readily obtained. Septal E/Ea＞14 had 83.33-92.31% sensitivity and 71.43-87.50% specificity for prediction of elevated PCWP. As with cutoff value of septal Ea/Aa＜0.95, Ea/Aa had 60.00-69.23% sensitivity and 57.14-87.50% specificity.
Conclusions: 1. High quality of TDI of mitral annulus, anterior and posterior left ventricle can be obtained with TEE. The success rate of sampling is higher at septal annulus, anterior and posterior of left ventricle than that at lateral site. Mitral flow velocity is much easier to get than pulmonary venous flow velocity.
2. EFs accessed by calculation and visual estimation are fast and accurate method to evaluate the systolic function. Septal and lateral annulus systolic velocity had a close relationship with the systolic function while anterior and posterior wall systolic velocity did not have.
3. Diastolic function: Although mitral flow velocity ratio(E/A) correlated with PCWP, it can not predict the elevated PCWP; The combination of TDI of the septal mitral annulus and mitral inflow velocity curves and septal annulus early and late velocity ratio provide better estimates of LV filling pressures than other parameters.
目的：探索IDT在心脏不同部位的频谱特征及采样成功率；分析TDI参数与肺动脉导管参数的相关性；评价TDI参数在心功能评价中的作用。
方法：冠状动脉旁路移植术患者40例，平均年龄63±7.8岁，窦性心律。同时进行TEE和肺动脉导管监测。肺动脉导管可持续监测心输出量(CO)，中心静脉压(CVP)和肺毛细血管嵌压(PCWP)。用TEE测量和评估患者射血分数(EF)，分别采集常规的二尖瓣(E、A)、左上肺静脉血流频谱(S、D)和TDI频谱(Sa，Ea，Aa)，同时记录肺动脉导管参数，分别将EF、TDI的心肌收缩速度Sa与CO，血流、TDI频谱参数与PCWP进行相关分析；另外，将患者按照心功能指标CI分组，对上述参数再进行相关分析，探讨TDI参数对不同心功能患者的评价作用；对相关良好的参数做出ROC曲线，进行比较找出TDI评价心功能的最佳参数。
结果：1．TEE采集心肌TDI频谱可显示心动周期内心肌收缩，舒张运动的方向、速度等信息，术中常用的采样点中，二尖瓣环室间隔和左室前、下壁采样成功率为(100％)，二尖瓣环侧壁采样成功率相对较低(95％)；采集二尖瓣血流频谱成功率100％；左上肺静脉成功率为85％。
2．心功能较好患者二尖瓣环收缩速度S_(侧壁)、S_(间隔)显著大于心功能较差的患者，S_(间隔)、S_(侧壁)与CO相关良好(r分别为0.606及0.438，P＜0.01)；S_(间隔)与CO在心功能较差的患者有良好相关性(r=0.653，P＜0.01)；目测EF及测量EF均与CO有良好的相关良好(r分别为0.626，0.627，P＜0.01)。
3血流频谱：二尖瓣瓣口血流速度E／A比值与PCWP相关分析中，心功能较差的患者((r=0.621，P＜0.01))比整体(r=0.377，P＜0.05)和心功能正常患者相关性好，肺静脉血流频谱与PCWP未发现相关关系
TDI频谱中：二尖瓣环舒张早期与晚期速度比Ea／Aa_(间隔)(r=—0.635，P＜0.01)、Ea／Aa_(侧壁)(r=-670，P＜0.01)与PCWP呈反相关且相关良好，其中Ea／Aa_(间隔)与PCWP相关性在不同心功能的患者(r分别为-0.802和-0.745)均有稳定的相关关系；结合参数：舒张早期二尖瓣血流速度与二尖瓣环运动速度比值E／Ea_(间隔)(r=0.699，P＜0.01)、E／Ea_(平均)(r=0.685，P＜0.01)、E／Ea_(侧壁)(r=0.681，P＜0.01)与PCWP呈正相关且相关良好，其中E／Ea_(间隔)(r分别为0.681 vs 0.738)和E／Ea_(平均)(r分别为0.760 vs 0.527，)在不同心功能患者与PCWP均有良好的相关关系，其余各参数均与PCWP无相关关系；
对有相关性参数以PCWP＞12mmHg为标准做ROC曲线分析：在综合比较各相关参数ROC曲线下面积可见E／Ea_(间隔)的曲线下面积＞Ea／Aa_(间隔)曲线下面积＞其他参数，血流频谱E／A比值得95％CI包含0.5，不能预测PCWP。确定E／Ea_(间隔)截断点为l4时，E／Ea_(间隔)预测PCWP＞12mmHg的敏感性为83.33-92.31％，特异性为71.43-87.50％；Ea／Aa_(间隔)截断点为0.95时，Ea／Aa_(间隔)预测PCWP＞12mmHg的敏感性60.00-69.23％，特异性为57.14-87.50％。
结论：1 TDI(?)采集心肌TDI频谱可显示心动周期内的心肌收缩，舒张运动的方向、速度等信息，术中常用的采样点中，二尖瓣环室间隔和左室前壁采样成功率高(100％)，二尖瓣环侧壁采样成功率相对较低(95％)；采集二尖瓣血流频谱成功率较高(100％)；左上肺静脉血流频谱成功率相对较低(85％)。
2术中TEE测量和目测EF可以快速准确地评价左室收缩功能；二尖瓣环间隔、侧壁心肌收缩速度，特别是间隔侧可反映左室收缩功能；左室前、后壁心肌收缩速度不能反映左室收缩功能。
3二尖瓣口血流频谱虽然与PCWP有相关关系，但并不能预测PCWP的升高，TDI频谱中血流速度和组织运动结合参数E／Ea_(间隔)预测左室舒张功能最好，其次为TDI参数Ea／Aa_(间隔)。
Background: Cardiac function is good predictor of outcome for cardiac surgery patients. Fast assessment and early intervention of left ventricular (LV) function provides an important information on the hemodynamic status and benefits the outcome and prognosis in the cardiac surgery patients. TDI(tissue Doppler imaging) is a new noninvasive technology of assessing movement of myocardium, which is used for evaluation of the cardiac function. However, there is no literatures on correlation between the TDI variables and pulmonary arterial catheter parameters(PAC) reported in cardiac surgery patients. This study is designed to analysis the relationship between the TDI variables and PAC parameters.
Objects: This study was to investigate the success rate of TDI and conventional Doppler sampling at different site of heart; to assess whether mitral annular velocities as measured by TDI are associated with invasive measures of PAC parameters and whether additional information is gained over traditional Doppler variables; to investigate the reliability of TDI in estimating left ventricular filling pressure.
Methods: We prospectively studied 40 patients, mean age 63±7.8 years, in sinus rhythm. All patients underwent CABG. Transesophageal echocardiography (TEE), pulmonary artery catheterization (PAC) and other hemodynamic monitoring were performed at the same time. PAC investigated continuous cardiac output (CCO), central venous pressure(CVP) and pulmonary capillary wedged pressure(PCWP). TEE-LVEF was calculated using M-mode analysis and vision assessment of wall motion of LV wall. The following Doppler parameters were assessed: PW Doppler signals from the mitral inflow (E, A), PW TDI of the mitral annulus (Sa, Ea, Aa), thus allowing to obtain the mitral inflow to annulus ratio (E/Ea). Correlations were analyzed between EFs、Sa and CO, and between the TDI parameters and PCWP. Then according to the CI＞2.0, patients were divided into 2 subgroups. Correlations were re-analyzed in the subgroups to identify the differences between two groups. ROC analysis was done for the correlated variables to identify the best parameter and cut-off value to predict elevation of PCWP.
Results: 1 TDI spectrums could be obtained from septal annulus, lateral annulus, anterior wall and posterior wall of left ventricle. The success rate of sampling from septal annulus, anterior and posterior wall is 100%, while the lateral annulus is 95%(2 cases unsuccessful). Mitral signal is more easly got with success rate of 100% than pulmonary venous signals with success rate of 85%.
2. For the systolic function, both annulus contraction velocity in septal and lateral wall are significantly higher(4.7±0.8, and 6.2±2.2) in normal function group than that(3.8±0.763.8±0.76 and 4.5±1.0) in abnormal group(P＜0.05); Septal and lateral contraction velocity correlated well with CO (r=0.606 and 0.438 respectively), and septal contraction velocity correlated with CO in abnormal group(r=0.653, P＜0.01). Both EFs investigated by calculation(r=0.627, P＜0.01) and vision assessment(r=0.626, P＜0.01) correlate well with CO as well.
3. Diastolic function: Although transmitral E/A ratio showed a better correlation with PCWP in abnormal group than that in whole patients, ROC analysis showed that it could not predict the PCWP elevation because 0.5 was included in 95% CI. Pulmonary venous velocity curves were not found have close relationship with PCWP in this study. For TDI of mitral annulus movements, early and late velocity ratio(Ea/Aa) at septal and lateral wall show an inverse correlation with PCWP(r=-0.635, and -0.670 respectively). Septal annulus Ea/Aa has a constant relationship with both normal and abnormal group(r=-0.635 and -0.670 repectively). The ratio of mitral velocity to early diastolic velocity of septal mitral annulus E/Ea(r=0.699, P＜0.01), mean E/Ea(r=0.685, P＜0.01)、lateral E/Ea (r=0.681, P＜0.01) ) showed a correlation with PCWP, and septal E/Ea间隔(r=0.681vs 0.738), mean E/Ea (r=0.760 vs 0.527,) had better correlation than did other Doppler variables for all levels of systolic function. The ROC analysis was repeated with PCWP＞12 mm Hg used as the definition of elevated filling pressure. The areas under the respective ROC curves were 0.905(septal E/Ea), 0.764(setal Ea/Aa), 0.732 (mean E/Ea ratio).
As with the cutoff value of E/Ea＞14 mm Hg, the septal E/Ea and lateral Ea/Aa had the best ROC curve and was the most readily obtained. Septal E/Ea＞14 had 83.33-92.31% sensitivity and 71.43-87.50% specificity for prediction of elevated PCWP. As with cutoff value of septal Ea/Aa＜0.95, Ea/Aa had 60.00-69.23% sensitivity and 57.14-87.50% specificity.
Conclusions: 1. High quality of TDI of mitral annulus, anterior and posterior left ventricle can be obtained with TEE. The success rate of sampling is higher at septal annulus, anterior and posterior of left ventricle than that at lateral site. Mitral flow velocity is much easier to get than pulmonary venous flow velocity.
2. EFs accessed by calculation and visual estimation are fast and accurate method to evaluate the systolic function. Septal and lateral annulus systolic velocity had a close relationship with the systolic function while anterior and posterior wall systolic velocity did not have.
3. Diastolic function: Although mitral flow velocity ratio(E/A) correlated with PCWP, it can not predict the elevated PCWP; The combination of TDI of the septal mitral annulus and mitral inflow velocity curves and septal annulus early and late velocity ratio provide better estimates of LV filling pressures than other parameters.
引文
1．王伟鹏．心血管手术术中经食管超声心动图的应用．麻醉与监护论坛，2003，10：341—346．
2．张晶；李立环；王伟鹏；赵小琴；李丽萍；刘进．经食管超声心动图监测在心血管手术患者中的应用．中华麻醉学杂志．2006，6：53-55
3．郜朝晖；杨浣宜；陈雷；张健；王伟鹏；倪新海；赵晓琴；多普勒组织成像技术在术中超声心动图检查中的应用．中华超声影像学杂志，2001，10：
4. Yamamoto K, Nishimura RA, Chaliki HP, et al. Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. J Am Coll Cardiol. 1997;30:1819-1826.
5．王伟鹏 南阳 李立环等．术中经食管超声诊断瓣膜置换后卡瓣一例报道。中华麻醉学杂志2001,21：573．
6. Practice guidenlines for perioperative transesophageal echocardiography. A report by the Amerticna Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 1996; 84: 986-1006.
7. Sheikh KH, de Bruijn NP, Rankin JS, et al. The utility of transesopageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery. JACC 1990; 15: 367-72.
8. Khandheria BK, Seward JB, Tajik J. Transesophageal echocardiography. Mayo Clin Proc 1994; 69: 856-63.
9. Cheung AT; Savino JS; Weiss SJ; Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 1994;81: 376-87
10. Cahalan MK; Ionescu P; Melton HE Automated real-time analysis of intraoperative transesophageal echocardiograms. Anesthesiology 1993; 78 477-85
11. Oh JK, Appleton CP, Hatle LK, et al. The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 1997; 10:246-270.
12. Brunazzi MC, Chirillo F, Pasqualini M, et al. Estimation of left ventricular diastolic pressures from precordial pulsed-Doppler analysis of pulmonary venous and mitral flow. Am Heart J. 1994;128:293-300.
13. Keren G, Sherez J, Megidish R, et al. Pulmonary venous flow pattern: its relationship to cardiac dynamics: a pulsed Doppler echocardiographic study. Circulation. 1985;71:1105-1112.
14. Kuecherer HF, Kusumoto F, Muhiudeen IA, et al. Pulmonary venous flow patterns by transesophageal pulsed Doppler echocardiography: relation to parameters of left ventricular systolic and diastolic function. Am Heart J. 1991;122:1683-1693.
15. Nishimura RA, Abel MD, Hatle LK, et al. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography: effect of different loading conditions. Circulation. 1990;81:1488-1497.
16. Rossvoll O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures [see comments]. J Am Coll Cardiol. 1993;21:1687-1696.
17. Yamamoto K, Nishimura RA, Burnett JC Jr, et al. Assessment of left ventricular end-diastolic pressure by Doppler echocardiography: contribution of duration of pulmonary venous versus mitral flow velocity curves at atrial contraction. J Am Soc Echocardiogr. 1997; 10:52-59.
18. Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone. J Am Coll Cardiol. 1997;30:8-18.
19. Choong CY, Herrmann HC, Weyman AE, et al. Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol. 1987;10:800-808.
20. Garcia MJ, Rodriguez L, Ares M, et al. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J. 1996; 132:648-656.
21. Genevieve D, Michel O, Joseph L, et al: Doppler Tissue Imaging Quantitates Regional Wall Motion During Myocardial Ischemia and Reperfusion Circulation. 1998;97:1970-1977.
22. Nixdorff U, Rupprecht HJ, Mohr-Kahaly S, et al. Tissue Doppler echocardiography: a new method of evaluating perfusion-dependent myocardial function during PTCA. Int J Card Imaging. 1997; 13:99-103.
23. Chenzbraun A, Keren A, Stern S. Doppler echocardiographic patterns of left ventricular filling in patients early after acute myocardial infarction. Am J Cardiol. 1992;70:711-714.
24. Dandel M, Hummel M, Wellnhofer E,et al: Tissue Doppler imaging for the assessment of systolic and diastolic ventricular function. J Am Soc Echocardiogr 2002 May; 15:478
25. Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre architecture in man. Br Heart J 1981; 45: 248-263
26. Jones CJ, Raposo L, Gibson DG. Functional importance of the long axis dynamics of the human left ventricle. Br Heart J 1990; 63: 215-220
27. Pai RG, Bodenheimer MM, Pai SM, Koss JH, Adamick RD. Usefulness of systolic excursion of the mitral annulus as an index of left ventricular systolic function. Am J Cardiol 1991; 67: 222-224
28. Zaky A,Grabhorn L,Feigenbaum H. Movement of the mitral ring: A study in ultrasound cardiography.Cardiovasc Res 1967,1:121-31
29. Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 1996; 77: 979-984
30.Oki T, Tabata T, Mishiro Y, Yamada H, Abe M, Onose Y, et al. Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes healthy subjects. J Am Soc Echocardiogr 1999; 12: 308-313
31. Galiuto L, Ignone G, De Maria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed wave tissue Doppler echocardiography. Am J Cardiol 1991; 67: 222-224
32. Pai RG, Gill KS. Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities: I. Their normal pattern and coupling to ventricular filling and ejection. J Am Soc Echocardiogr 1998; 11: 105-111
33. Gorcsan J 3rd, Gulati VK, Mandarino WA, Katz WE. Color-coded measures of myocardial velocity throughout the cardiac cycle by tissue Doppler imaging to
47. Eriksson SV, Bjorkander I, Held C, et al. Age and gender differences in left ventricular function among patients with stable angina and a matched control group: a report from the Angina Prognosis Study in Stockholm. Cardiology. 1996;87:287-293.
48. Rihal CS, Nishimura RA, Hatle LK, et al. Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy: relation to symptoms and prognosis. Circulation. 1994;90:2772-2779.
49. Temporelli PL, Corra U, Imparato A, et al. Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure. J Am Coll Cardiol. 1998;31:1591-1597.
50. Nishimura RA, Appleton CP, Redfield MM, et al. Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol. 1996;28:1226-1233.
51. Aranda JM Jr, Weston MW, Puleo JA, et al. Effect of loading conditions on myocardial relaxation velocities determined by Doppler tissue imaging in heart transplant recipients. J Heart Lung Transplant. 1998; 17:693-697.
52. Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997;30:474-480.
53. Garcia MJ, Rodriguez L, Ares M, et al. Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol. 1996;27:108-114.
54. Bach DS. Quantitative Doppler tissue imaging as a correlate of left ventricular contractility. International Journal of Cardiac Imaging. 1996;12:191-195.
55. Gulati VK, Katz WE, Follansbee WP, et al. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiology. 1996;77:979-984.
56. Nagueh S, Middleton K, Koplen H, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527-1533.
57. Nagueh SF, Mikati I, Kopelen HA, et al. Doppler estimation of left ventricular filling pressure in sinus tachycardia: a new application of tissue Doppler imaging. Circulation. 1998;98:1644-1650.
58. Nagueh SF, Lakkis NM, Middleton KJ, et al. Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation. 1999;99:254-261.
59. Ommen S. R.; Nishimura R. A., Appleton C. P., et al.Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures. Circulation. 2000; 102:1788
1. Hoffmann R, Hanrath R Stress echocardiography: the scourge of subjective interpretation. Eur Heart J 1995; 16:1458-1459
2. Hoffmann R, Marwick TH, Poldermans D, et al. Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms. Eur Heart J 2002; 23:821-829
3. Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A. Stress echocardiography and the human factor: the importance of being an expert. J Am Coll Cardiol 1990; 17: 666-667
4. McDicken WN, Sutherland GR, Moran CM, et al. Color Doppler velocity imaging of the myocardlum. Ultrasound Med Biol 1992, 18: 651
5. Lange A, Palka P, Caso P, Fenn LN, Olszewski R, Ramo MP, et al. Doppler myocardial imaging vs. B-mode grey-scale imaging: a comparative in vitro and in vivo study into their relative efficacy in endocardial boundary detection. Ultrasound Med Biol 1997; 23:69-75
6. Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C. Doppler echocardiographic measurementof low velocity motion of the left ventricular posterior wall. Am J Cardiol 1989; 64:66-75
7. Rushmer RF, Crystal DK, Wagner C. The functional anatomy of ventricular contraction. Cir Res 1953; 1: 162-170
8. Grant RP. Notes on the muscular architechture of the left ventricle. Circulation 1965; 32:301-308
9. Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre architecture in man. Br Heart J 1981; 45: 248-263
10. Jones CJ, Raposo L, Gibson DG. Functional importance of the long axis dynamics of the human left ventricle. Br Heart J 1990; 63: 215-220
11. Pai RG, Bodenheimer MM, Pai SM, Koss JH, Adamick RD. Usefulness of systolic excursion of the mitral annulus as an index of left ventricular systolic function. Am J Cardiol 1991;67: 222-224
12. Simonson JS, Schiller NB. Descent of the base of the left ventricle: an echocardiographic index of left ventricular function. J Am Soc Echocardiogr 1989; 2: 25-35
13. Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 1996; 77: 979-984
14. Oki T, Tabata T, Mishiro Y, Yamada H, Abe M, Onose Y, et al. Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes healthy subjects. J Am Soc Echocardiogr 1999; 12:308-313
15. Galiuto L, Ignone G, De Maria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed wave tissue Doppler echocardiography. Am J Cardiol 1991; 67: 222-224
16. Pai RG, Gill KS. Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities: I. Their normal pattern and coupling to ventricular filling and ejection. J Am Soc Echocardiogr 1998; 11: 105-111
17. Gorcsan J 3rd, Gulati VK, Mandarino WA, Katz WE. Color-coded measures of myocardial velocity throughout the cardiac cycle by tissue Doppler imaging to quantify regional left ventricular function. Am Heart J 1996; 131: 1203-1213
18. Uematsu M, Miyatake K, Tanaka N, Matsuda H, Sano A, Yamazaki N, et al. Myocardial velocity gradient as a new indicator of regional left ventricular contraction: detection by a two-dimensional tissue Doppler imaging technique. J Am Coll Cardiol 1995;26:217-223
19. Onose Y, Oki T, Mishiro Y, Yamada H, Abe M, Manabe K, et al. Influence of aging on systolic left ventricular wall motion velocities along the long and short axes in clinically normal patients determined by pulsed tissue doppler imaging. J Am Soc Echocardiogr 1999; 12: 921-926
20. Yamada H, Oki T, Mishiro Y, Tabata T, Abe M, Onose Y, et al. Effect of aging on diastolic left ventricular myocardial velocities measured by pulsed tissue Doppler imaging in healthy subjects. J Am Soc Echocardiogr 1999; 12: 574-581
21. Shan K, Bick RJ, Poindexter BJ, Shimoni S, Letsou GV, Reardon MJ, et al. Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans. J Am Coll Cardiol 2000; 36: 891-896
22. Yamada H, Oki, Tabata, T. Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imaging: comparison with peak dp/dt of the left ventricular pressure curve. J Am Soc Echocardiogr 1998,11:442
23. Erbel R Nesser HJ Drozdz J. Atlas of tissue Doppler Echocardiography TDE, 1995,115
24. Bojjc D, Todorovic S, Poporic AD, et al. Early detection od regional myocardial asynergy induchenne muscular dystrophy detected by Doppler tissue iaging. Echocardiography 1997,14:370
25. Mishiro Y, Oki T, Yamada H, Wakatsuki T, Ito S. Evaluation of left ventricular contraction abnormalities in patients with dilated cardiomyopathy with the use of pulsed tissue Doppler imaging. J Am Soc Echocardiogr 1999; 12: 913-920
26. Yamada H, Oki T, Tabata T, Iuchi A, Ito S. Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imaging: comparison with peak dP/dt of the left ventricular pressure curve. J Am Soc Echocardiogr 1998; 11: 442-449
27. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997; 30: 474-480
28. Sundereswaran L, Naguch SF, Vardan S, et al. Estimation of left and right ventricular filling pressures after heart transplantation by tissue Doppler imaging. Am J Cardiol 1998,82:352.
29. Hada Y, Itoh N, Asakawa M. Left ventricular wall motion dynamics of asymmetric septal hypertrophy: assessment by intramyocardial pulsed Doppler echocardiogrphy. J Cardiol 1998, 31:351
30. Derumeaux G, Ovize M, Loufoua J, Andre-Fouet X, Minaire Y, Cribier A, et al. Doppler tissue imaging quantitates regional wall motion during myocardial ischemia and reperfusion. Circulation 1998; 97: 1970-1977
31. Pislaru C, Bruce CJ, Belohlavek M, Seward JB, Greenleaf JF. Intracardiac measurement of pre-ejection myocardial velocities estimates the transmural extent of viable myocardium early after reperfusion in acute myocardial infarction. J Am Coll Cardiol 2001; 38: 1748-1756
32. Garcia-Fernandez MA, Azevedo J, Moreno M, Bermejo J, Perez-Castellano N, Puerta P, et al. Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging. Eur Heart J 1999; 20: 496-505
33. Bolognesi R, Tsialtas D, Barilli AL, Manca C, Zeppellini R, Javernaro A, et al. Detection of early abnormalities of left ventricular function by hemodynamic, echo-tissue Doppler imaging, and mitral Doppler flow techniques in patients with coronary artery disease and normal ejection fraction. J Am Soc Echocardiogr 2001; 14: 764-772
34. Katz WE, Gulati VK, Mahler CM, Gorcsan J 3rd, Quantitative evaluation of the segmental left ventricular response to dobutamine stress by tissue Doppler echocardiography. Am J Cardiol 1997; 79: 1036-1042
35. Larrazet F, Pellerin D, Daou D, Witchitz S, Fournier C, Prigent A, et al. Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium. Heart 1999; 82: 432-437
36. Nishino M, Tanouchi J, Tanaka K, Ito T, Kato J, Iwai K, et al. Dobutamine stress echocardiography at 7.5 mg/kg/min using color tissue Doppler imaging M-mode safely predicts reversible dysfunction early after reperfusion in patients with acute myocardial infarction. Am J Cardiol 1999; 83:340-344
37. Fathi R, Cain P, Nakatani S, Yu HC, Marwick TH. Effect of tissue Doppler on the accuracy of novice and expert interpreters of dobutamine echocardiography. Am J Cardiol 2001; 88:400—405
38．李峻，李治安，王新房，等．多普勒组织成像技术在冠心病的冷加压负荷超声心动图中的应用研究．中国医学影像技术 1998，14：25
39. Sogaard P, Kim WY, Jensen HK, Mortensen P, Pedersen AK, Kristensen BO, et al. Impact of acute biventricular pacing on left ventricular performance and volumes in patients with severe heart failure. A tissue doppler and three-dimensional echocardiographic study. Cardiology 2001; 95:173-182
40. Dandel M, Hummel M, Muller J, Wellnhofer E, Meyer R, Solowjowa N, et al. Reliability of tissue Doppler wall motion monitoring after heart transplantation for replacement of invasive routine screenings by optimally timed cardiac biopsies and catheterizations. Circulation 2001; 104: Ⅰ184—Ⅰ191
41. Vinereanu D, Florescu N, Sculthorpe N, Tweddel AC, Stephens MR, Fraser AG. Differentiation between pathologic and physiologic left ventricular hypertrophy by tissue Doppler assessment of long-axis function in patients with hypertrophic cardiomyopathy or systemic hypertension and in athletes. Am J Cardiol 2001; 88: 53-58
42．吴棘，李治安，王新房，等．多普勒组织成像技术评价肥厚型心肌病舒张功能．中国医学影像技术 1999，15：9
43．吴棘，李治安，王新房，等．多普勒组织成像技术评估扩张型心肌病舒张功能．中国医学影像技术 1999，15：13
1. Edler I, Hertz CH. The use of ultrasonic reflectoschope for the continuous recording of the move4ments of heart walls. Kungliga Fysiografiska Sallskapets Ⅰ Lund Forhandingar 1954, 24:1-19.
2. Side CG, Gosling RG. Non-surgical assessment of cardiac function. Nature 1971; 232: 335.
3. Frazin L, Talano JV, Stephanides L, et al. Esophageal echocardiography. Circulation 1976; 54: 102.
4. Hisanaga K, Hisanaga A, Nagata K, et al. A new transesophageal real-time two-dimensional echocardiographic system using a flexible tube and its clinical application. Proc Jpn soc Ultrason Med 1977; 32; 43-44.
5. Souquet J, Hanrath P, Zitelli L, et al. Transesophageal phased array for imaging the heart. IEEE Trans Biomed Eng 1982; 29: 707.
6. Chapman JV, Vandenbogaerde J, Everaert JA, et al. The initial clinical evaluation of a transesophageal system with pulsed Doppler, continuous wave Doppler, and color flow imaging based on an annular array technology. Int J Cardiac Imaging 1989; 5: 9-16.
7. Buckmaster MJ et al: Further experience eith transesophageal echocardiography in the evaluation of thoracic aortic injury. J Trauma 1994; 37:989-95
8. Torossov M, et al: Clinical presentation, diagnosis, and hospital outcome of patients with documented aortic dissection: the Albany Medical Center experience, 1986 to 1996. Am Heart J 1999; 137:154-61
9. Nienaber CA, et al: The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993;328-9
10. Oxorn D, Edelist G, Smith MS. An introduction to transoesophageal echocardiography: II. Clinical applications. Can J Anaesth 1996; 43: 279-94.
11. Roelandt JRTC, souquet J, Djoa KK, et al: History and Development.p1-10. In Roelandt JRTC, Pandian NG(eds): Multiplane Transesophageal Echocardiography. Churchill Livingstone Inc. 1996.
12. Sheikh KH, et al: Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation 1991; 84:594-604
13. :Nowrangi SK, et al: Impact of intraoperative transesphageal echocardiography among patients undergoing aortic valve replacement for aortic stenosis. J Am Soc Echocardiogr 2001; 14:863-6.
14. Konstadt SN, Reich DL, Kahn R, et al. Transesophageal echocardiography can be used to screen for ascending aortic atherosclerosis. Anesth Analg 1995; 81: 225-8.
15. Katz ES, et al: Protrding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992; 20:70-7
16. Khandheria BK, Seward JB, Tajik J. Transesophageal echocardiography. Mayo Clin Proc 1994; 69: 856-63.
17. Cheung AT; Savino JS; Weiss SJ; Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 1994;81: 376-87
18. Cahalan MK; Ionescu P; Melton HE Automated real-time analysis of intraoperative transesophageal echocardiograms. Anesthesiology 1993; 78 477-85
19. Smith JS, Cahalan MK, Benefiel DJ, et al. Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two dimensional transesophageal echocardiography. Circulation 1985; 72: 1015-21.
20. Heidenreich, R. F. Stainback, R. F. Redberg, N. B et al: Transesophageal echocardiography predicts mortality in critically ill patients with unexplained hypotension J Am Coll Cardiol 1995; 26: 152-8,
21. Savino JS; Troianos CA; Aukburg S et al: Measurement of pulmonary blood flow with transesophageal two-dimensional and Doppler echocardiography Anesthesiology, 1991 : 75:445-51
22. Darmon PL; Hillel Z; Mogtader A; Mindich B et al: Cardiac output by transesophageal echocardiography using continuous-wave Doppler across the aortic valve. Anesthesiology1994; 80:796-805
23. Feinberg MS; Hopkins WE; Davila-Roman VG, et al: Multiplane transesophageal echocardiographic doppler imaging accurately determines cardiac output measurements in critically ill patients. Chest 1995; 107:769-73
24．王伟鹏，张东亚，吴学仁，胡小琴：不同部位放置中心静脉管到位率的观察。中国循环杂志 1995；10：113—114。
25．王伟鹏，刘进，胡盛寿．微创心脏外科及麻醉．微创外科杂志2001，1：39—42。
26．王伟鹏，陈雷，于钦军等：Port-Access心脏手术中的监测微创外科杂志2001，1：
27. Practice guidenlines for perioperative transesophageal echocardiography. A report by the Amerticna Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 1996; 84: 986-1006.
28. Sheikh KH, de Bruijn NP, Rankin JS, et al. The utility of transesopageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery. JACC 1990; 15: 367-72.
29. Sheikh KH, Bengtson JR, Rankin JS, et al. Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation 1991; 84: 594-604.
30. Katz ES, Tunick PA, Rusinek H, et al. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopumonary bypass: experience with intraoperative transesophageal echocardiography. JACC 1992; 20: 70-7.
31．袁定华，李守平，杨浣宜，等．胸主动脉病变术中经食管超声应用初探．中国循环杂志，1996，11(2)：76-78．
32. Flachskampf FA, O'shea JP, Griffin BP, et al. Patterns of Normal Transvalvular Regurgitation in Mechanical Valve prostheses. JACC 1991; 18: 1493-8.
33. Flachskampf FA, Hoffmann R, Franke A, et al. Does multiplane transesophageal echocardiography improve the assessment of prosthetic valve regurgitation? J Am Soc Echocardiogr 1995; 8: 70-8.
34. Yumoto M, Katsuya H: Transesophageal echocardiography for cardiac surgery in children. J of Cardiothoracic and Vascular Anesthesia, 2002; 16:587-91
35．王伟鹏 李立环 常勇男 等：经食管超声心动图在肥厚型梗阻性心肌病手术中的应用．2002年中华医学会全国麻醉学术年会论文摘要汇编．636．南京
36. Stevenson JG, Sorensen GK, Gartman DM, et al. Left ventricular outflow tract obstruction: an indication for intraoperative transesophageal echocardiography. J Am Soc Echocardiogr 1993; 6:525-35
37. Bettex DA, Vogt PR, Jermi R, Schmid ER. Unusual intraoperative impact of transesophageal echocardiography during the correction of a persistent pseudoaneurysm perfused from the left ventricular outflow tract. J Cardiothorac Vasc Anesth 2002; 16:80-82
38. Ashidagawa M, Ohara M, Koide Y. An intraoperative diagnosis of dynamic left ventricular outflow tract obstruction using transesophageal echocardiography leads to the treatment with intravenous disopyramide. Anesth Analg 2002; 94:310-2
39. Reichert CL; Visser CA; Koolen JJ et al: Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters. J Thorac Cardiovasc Surg 1992; 104:321-6
40. Cicek S, et al: Tansesophageal echocardiography in cardiac surgical emergenies. J Card Surg 1995:10:236-44
41. Cook CH et al: Transthoracic echocardiography is not cost-effective in critically ill surgical patients. J Trauma 2002; 52:280-4
42. Sohn DW; Shin GJ; Oh JK et al:Role of transesophageal echocardiography in hemodynamically unstable patients. Mayo Clin Procl995; 70: 925-31
43. Poelaert JI; Trouerbach J; De Buyzere M et al: Evaluation of transesophageal echocardiography as a diagnostic and therapeutic aid in a critical care setting.Chest 1995; 107: 774-9
2．张晶；李立环；王伟鹏；赵小琴；李丽萍；刘进．经食管超声心动图监测在心血管手术患者中的应用．中华麻醉学杂志．2006，6：53-55
3．郜朝晖；杨浣宜；陈雷；张健；王伟鹏；倪新海；赵晓琴；多普勒组织成像技术在术中超声心动图检查中的应用．中华超声影像学杂志，2001，10：
4. Yamamoto K, Nishimura RA, Chaliki HP, et al. Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. J Am Coll Cardiol. 1997;30:1819-1826.
5．王伟鹏 南阳 李立环等．术中经食管超声诊断瓣膜置换后卡瓣一例报道。中华麻醉学杂志2001,21：573．
6. Practice guidenlines for perioperative transesophageal echocardiography. A report by the Amerticna Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 1996; 84: 986-1006.
7. Sheikh KH, de Bruijn NP, Rankin JS, et al. The utility of transesopageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery. JACC 1990; 15: 367-72.
8. Khandheria BK, Seward JB, Tajik J. Transesophageal echocardiography. Mayo Clin Proc 1994; 69: 856-63.
9. Cheung AT; Savino JS; Weiss SJ; Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 1994;81: 376-87
10. Cahalan MK; Ionescu P; Melton HE Automated real-time analysis of intraoperative transesophageal echocardiograms. Anesthesiology 1993; 78 477-85
11. Oh JK, Appleton CP, Hatle LK, et al. The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 1997; 10:246-270.
12. Brunazzi MC, Chirillo F, Pasqualini M, et al. Estimation of left ventricular diastolic pressures from precordial pulsed-Doppler analysis of pulmonary venous and mitral flow. Am Heart J. 1994;128:293-300.
13. Keren G, Sherez J, Megidish R, et al. Pulmonary venous flow pattern: its relationship to cardiac dynamics: a pulsed Doppler echocardiographic study. Circulation. 1985;71:1105-1112.
14. Kuecherer HF, Kusumoto F, Muhiudeen IA, et al. Pulmonary venous flow patterns by transesophageal pulsed Doppler echocardiography: relation to parameters of left ventricular systolic and diastolic function. Am Heart J. 1991;122:1683-1693.
15. Nishimura RA, Abel MD, Hatle LK, et al. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography: effect of different loading conditions. Circulation. 1990;81:1488-1497.
16. Rossvoll O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures [see comments]. J Am Coll Cardiol. 1993;21:1687-1696.
17. Yamamoto K, Nishimura RA, Burnett JC Jr, et al. Assessment of left ventricular end-diastolic pressure by Doppler echocardiography: contribution of duration of pulmonary venous versus mitral flow velocity curves at atrial contraction. J Am Soc Echocardiogr. 1997; 10:52-59.
18. Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone. J Am Coll Cardiol. 1997;30:8-18.
19. Choong CY, Herrmann HC, Weyman AE, et al. Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol. 1987;10:800-808.
20. Garcia MJ, Rodriguez L, Ares M, et al. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J. 1996; 132:648-656.
21. Genevieve D, Michel O, Joseph L, et al: Doppler Tissue Imaging Quantitates Regional Wall Motion During Myocardial Ischemia and Reperfusion Circulation. 1998;97:1970-1977.
22. Nixdorff U, Rupprecht HJ, Mohr-Kahaly S, et al. Tissue Doppler echocardiography: a new method of evaluating perfusion-dependent myocardial function during PTCA. Int J Card Imaging. 1997; 13:99-103.
23. Chenzbraun A, Keren A, Stern S. Doppler echocardiographic patterns of left ventricular filling in patients early after acute myocardial infarction. Am J Cardiol. 1992;70:711-714.
24. Dandel M, Hummel M, Wellnhofer E,et al: Tissue Doppler imaging for the assessment of systolic and diastolic ventricular function. J Am Soc Echocardiogr 2002 May; 15:478
25. Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre architecture in man. Br Heart J 1981; 45: 248-263
26. Jones CJ, Raposo L, Gibson DG. Functional importance of the long axis dynamics of the human left ventricle. Br Heart J 1990; 63: 215-220
27. Pai RG, Bodenheimer MM, Pai SM, Koss JH, Adamick RD. Usefulness of systolic excursion of the mitral annulus as an index of left ventricular systolic function. Am J Cardiol 1991; 67: 222-224
28. Zaky A,Grabhorn L,Feigenbaum H. Movement of the mitral ring: A study in ultrasound cardiography.Cardiovasc Res 1967,1:121-31
29. Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 1996; 77: 979-984
30.Oki T, Tabata T, Mishiro Y, Yamada H, Abe M, Onose Y, et al. Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes healthy subjects. J Am Soc Echocardiogr 1999; 12: 308-313
31. Galiuto L, Ignone G, De Maria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed wave tissue Doppler echocardiography. Am J Cardiol 1991; 67: 222-224
32. Pai RG, Gill KS. Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities: I. Their normal pattern and coupling to ventricular filling and ejection. J Am Soc Echocardiogr 1998; 11: 105-111
33. Gorcsan J 3rd, Gulati VK, Mandarino WA, Katz WE. Color-coded measures of myocardial velocity throughout the cardiac cycle by tissue Doppler imaging to
47. Eriksson SV, Bjorkander I, Held C, et al. Age and gender differences in left ventricular function among patients with stable angina and a matched control group: a report from the Angina Prognosis Study in Stockholm. Cardiology. 1996;87:287-293.
48. Rihal CS, Nishimura RA, Hatle LK, et al. Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy: relation to symptoms and prognosis. Circulation. 1994;90:2772-2779.
49. Temporelli PL, Corra U, Imparato A, et al. Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure. J Am Coll Cardiol. 1998;31:1591-1597.
50. Nishimura RA, Appleton CP, Redfield MM, et al. Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol. 1996;28:1226-1233.
51. Aranda JM Jr, Weston MW, Puleo JA, et al. Effect of loading conditions on myocardial relaxation velocities determined by Doppler tissue imaging in heart transplant recipients. J Heart Lung Transplant. 1998; 17:693-697.
52. Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997;30:474-480.
53. Garcia MJ, Rodriguez L, Ares M, et al. Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol. 1996;27:108-114.
54. Bach DS. Quantitative Doppler tissue imaging as a correlate of left ventricular contractility. International Journal of Cardiac Imaging. 1996;12:191-195.
55. Gulati VK, Katz WE, Follansbee WP, et al. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiology. 1996;77:979-984.
56. Nagueh S, Middleton K, Koplen H, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527-1533.
57. Nagueh SF, Mikati I, Kopelen HA, et al. Doppler estimation of left ventricular filling pressure in sinus tachycardia: a new application of tissue Doppler imaging. Circulation. 1998;98:1644-1650.
58. Nagueh SF, Lakkis NM, Middleton KJ, et al. Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation. 1999;99:254-261.
59. Ommen S. R.; Nishimura R. A., Appleton C. P., et al.Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures. Circulation. 2000; 102:1788
1. Hoffmann R, Hanrath R Stress echocardiography: the scourge of subjective interpretation. Eur Heart J 1995; 16:1458-1459
2. Hoffmann R, Marwick TH, Poldermans D, et al. Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms. Eur Heart J 2002; 23:821-829
3. Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A. Stress echocardiography and the human factor: the importance of being an expert. J Am Coll Cardiol 1990; 17: 666-667
4. McDicken WN, Sutherland GR, Moran CM, et al. Color Doppler velocity imaging of the myocardlum. Ultrasound Med Biol 1992, 18: 651
5. Lange A, Palka P, Caso P, Fenn LN, Olszewski R, Ramo MP, et al. Doppler myocardial imaging vs. B-mode grey-scale imaging: a comparative in vitro and in vivo study into their relative efficacy in endocardial boundary detection. Ultrasound Med Biol 1997; 23:69-75
6. Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C. Doppler echocardiographic measurementof low velocity motion of the left ventricular posterior wall. Am J Cardiol 1989; 64:66-75
7. Rushmer RF, Crystal DK, Wagner C. The functional anatomy of ventricular contraction. Cir Res 1953; 1: 162-170
8. Grant RP. Notes on the muscular architechture of the left ventricle. Circulation 1965; 32:301-308
9. Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre architecture in man. Br Heart J 1981; 45: 248-263
10. Jones CJ, Raposo L, Gibson DG. Functional importance of the long axis dynamics of the human left ventricle. Br Heart J 1990; 63: 215-220
11. Pai RG, Bodenheimer MM, Pai SM, Koss JH, Adamick RD. Usefulness of systolic excursion of the mitral annulus as an index of left ventricular systolic function. Am J Cardiol 1991;67: 222-224
12. Simonson JS, Schiller NB. Descent of the base of the left ventricle: an echocardiographic index of left ventricular function. J Am Soc Echocardiogr 1989; 2: 25-35
13. Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 1996; 77: 979-984
14. Oki T, Tabata T, Mishiro Y, Yamada H, Abe M, Onose Y, et al. Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes healthy subjects. J Am Soc Echocardiogr 1999; 12:308-313
15. Galiuto L, Ignone G, De Maria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed wave tissue Doppler echocardiography. Am J Cardiol 1991; 67: 222-224
16. Pai RG, Gill KS. Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities: I. Their normal pattern and coupling to ventricular filling and ejection. J Am Soc Echocardiogr 1998; 11: 105-111
17. Gorcsan J 3rd, Gulati VK, Mandarino WA, Katz WE. Color-coded measures of myocardial velocity throughout the cardiac cycle by tissue Doppler imaging to quantify regional left ventricular function. Am Heart J 1996; 131: 1203-1213
18. Uematsu M, Miyatake K, Tanaka N, Matsuda H, Sano A, Yamazaki N, et al. Myocardial velocity gradient as a new indicator of regional left ventricular contraction: detection by a two-dimensional tissue Doppler imaging technique. J Am Coll Cardiol 1995;26:217-223
19. Onose Y, Oki T, Mishiro Y, Yamada H, Abe M, Manabe K, et al. Influence of aging on systolic left ventricular wall motion velocities along the long and short axes in clinically normal patients determined by pulsed tissue doppler imaging. J Am Soc Echocardiogr 1999; 12: 921-926
20. Yamada H, Oki T, Mishiro Y, Tabata T, Abe M, Onose Y, et al. Effect of aging on diastolic left ventricular myocardial velocities measured by pulsed tissue Doppler imaging in healthy subjects. J Am Soc Echocardiogr 1999; 12: 574-581
21. Shan K, Bick RJ, Poindexter BJ, Shimoni S, Letsou GV, Reardon MJ, et al. Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans. J Am Coll Cardiol 2000; 36: 891-896
22. Yamada H, Oki, Tabata, T. Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imaging: comparison with peak dp/dt of the left ventricular pressure curve. J Am Soc Echocardiogr 1998,11:442
23. Erbel R Nesser HJ Drozdz J. Atlas of tissue Doppler Echocardiography TDE, 1995,115
24. Bojjc D, Todorovic S, Poporic AD, et al. Early detection od regional myocardial asynergy induchenne muscular dystrophy detected by Doppler tissue iaging. Echocardiography 1997,14:370
25. Mishiro Y, Oki T, Yamada H, Wakatsuki T, Ito S. Evaluation of left ventricular contraction abnormalities in patients with dilated cardiomyopathy with the use of pulsed tissue Doppler imaging. J Am Soc Echocardiogr 1999; 12: 913-920
26. Yamada H, Oki T, Tabata T, Iuchi A, Ito S. Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imaging: comparison with peak dP/dt of the left ventricular pressure curve. J Am Soc Echocardiogr 1998; 11: 442-449
27. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997; 30: 474-480
28. Sundereswaran L, Naguch SF, Vardan S, et al. Estimation of left and right ventricular filling pressures after heart transplantation by tissue Doppler imaging. Am J Cardiol 1998,82:352.
29. Hada Y, Itoh N, Asakawa M. Left ventricular wall motion dynamics of asymmetric septal hypertrophy: assessment by intramyocardial pulsed Doppler echocardiogrphy. J Cardiol 1998, 31:351
30. Derumeaux G, Ovize M, Loufoua J, Andre-Fouet X, Minaire Y, Cribier A, et al. Doppler tissue imaging quantitates regional wall motion during myocardial ischemia and reperfusion. Circulation 1998; 97: 1970-1977
31. Pislaru C, Bruce CJ, Belohlavek M, Seward JB, Greenleaf JF. Intracardiac measurement of pre-ejection myocardial velocities estimates the transmural extent of viable myocardium early after reperfusion in acute myocardial infarction. J Am Coll Cardiol 2001; 38: 1748-1756
32. Garcia-Fernandez MA, Azevedo J, Moreno M, Bermejo J, Perez-Castellano N, Puerta P, et al. Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging. Eur Heart J 1999; 20: 496-505
33. Bolognesi R, Tsialtas D, Barilli AL, Manca C, Zeppellini R, Javernaro A, et al. Detection of early abnormalities of left ventricular function by hemodynamic, echo-tissue Doppler imaging, and mitral Doppler flow techniques in patients with coronary artery disease and normal ejection fraction. J Am Soc Echocardiogr 2001; 14: 764-772
34. Katz WE, Gulati VK, Mahler CM, Gorcsan J 3rd, Quantitative evaluation of the segmental left ventricular response to dobutamine stress by tissue Doppler echocardiography. Am J Cardiol 1997; 79: 1036-1042
35. Larrazet F, Pellerin D, Daou D, Witchitz S, Fournier C, Prigent A, et al. Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium. Heart 1999; 82: 432-437
36. Nishino M, Tanouchi J, Tanaka K, Ito T, Kato J, Iwai K, et al. Dobutamine stress echocardiography at 7.5 mg/kg/min using color tissue Doppler imaging M-mode safely predicts reversible dysfunction early after reperfusion in patients with acute myocardial infarction. Am J Cardiol 1999; 83:340-344
37. Fathi R, Cain P, Nakatani S, Yu HC, Marwick TH. Effect of tissue Doppler on the accuracy of novice and expert interpreters of dobutamine echocardiography. Am J Cardiol 2001; 88:400—405
38．李峻，李治安，王新房，等．多普勒组织成像技术在冠心病的冷加压负荷超声心动图中的应用研究．中国医学影像技术 1998，14：25
39. Sogaard P, Kim WY, Jensen HK, Mortensen P, Pedersen AK, Kristensen BO, et al. Impact of acute biventricular pacing on left ventricular performance and volumes in patients with severe heart failure. A tissue doppler and three-dimensional echocardiographic study. Cardiology 2001; 95:173-182
40. Dandel M, Hummel M, Muller J, Wellnhofer E, Meyer R, Solowjowa N, et al. Reliability of tissue Doppler wall motion monitoring after heart transplantation for replacement of invasive routine screenings by optimally timed cardiac biopsies and catheterizations. Circulation 2001; 104: Ⅰ184—Ⅰ191
41. Vinereanu D, Florescu N, Sculthorpe N, Tweddel AC, Stephens MR, Fraser AG. Differentiation between pathologic and physiologic left ventricular hypertrophy by tissue Doppler assessment of long-axis function in patients with hypertrophic cardiomyopathy or systemic hypertension and in athletes. Am J Cardiol 2001; 88: 53-58
42．吴棘，李治安，王新房，等．多普勒组织成像技术评价肥厚型心肌病舒张功能．中国医学影像技术 1999，15：9
43．吴棘，李治安，王新房，等．多普勒组织成像技术评估扩张型心肌病舒张功能．中国医学影像技术 1999，15：13
1. Edler I, Hertz CH. The use of ultrasonic reflectoschope for the continuous recording of the move4ments of heart walls. Kungliga Fysiografiska Sallskapets Ⅰ Lund Forhandingar 1954, 24:1-19.
2. Side CG, Gosling RG. Non-surgical assessment of cardiac function. Nature 1971; 232: 335.
3. Frazin L, Talano JV, Stephanides L, et al. Esophageal echocardiography. Circulation 1976; 54: 102.
4. Hisanaga K, Hisanaga A, Nagata K, et al. A new transesophageal real-time two-dimensional echocardiographic system using a flexible tube and its clinical application. Proc Jpn soc Ultrason Med 1977; 32; 43-44.
5. Souquet J, Hanrath P, Zitelli L, et al. Transesophageal phased array for imaging the heart. IEEE Trans Biomed Eng 1982; 29: 707.
6. Chapman JV, Vandenbogaerde J, Everaert JA, et al. The initial clinical evaluation of a transesophageal system with pulsed Doppler, continuous wave Doppler, and color flow imaging based on an annular array technology. Int J Cardiac Imaging 1989; 5: 9-16.
7. Buckmaster MJ et al: Further experience eith transesophageal echocardiography in the evaluation of thoracic aortic injury. J Trauma 1994; 37:989-95
8. Torossov M, et al: Clinical presentation, diagnosis, and hospital outcome of patients with documented aortic dissection: the Albany Medical Center experience, 1986 to 1996. Am Heart J 1999; 137:154-61
9. Nienaber CA, et al: The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993;328-9
10. Oxorn D, Edelist G, Smith MS. An introduction to transoesophageal echocardiography: II. Clinical applications. Can J Anaesth 1996; 43: 279-94.
11. Roelandt JRTC, souquet J, Djoa KK, et al: History and Development.p1-10. In Roelandt JRTC, Pandian NG(eds): Multiplane Transesophageal Echocardiography. Churchill Livingstone Inc. 1996.
12. Sheikh KH, et al: Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation 1991; 84:594-604
13. :Nowrangi SK, et al: Impact of intraoperative transesphageal echocardiography among patients undergoing aortic valve replacement for aortic stenosis. J Am Soc Echocardiogr 2001; 14:863-6.
14. Konstadt SN, Reich DL, Kahn R, et al. Transesophageal echocardiography can be used to screen for ascending aortic atherosclerosis. Anesth Analg 1995; 81: 225-8.
15. Katz ES, et al: Protrding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992; 20:70-7
16. Khandheria BK, Seward JB, Tajik J. Transesophageal echocardiography. Mayo Clin Proc 1994; 69: 856-63.
17. Cheung AT; Savino JS; Weiss SJ; Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 1994;81: 376-87
18. Cahalan MK; Ionescu P; Melton HE Automated real-time analysis of intraoperative transesophageal echocardiograms. Anesthesiology 1993; 78 477-85
19. Smith JS, Cahalan MK, Benefiel DJ, et al. Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two dimensional transesophageal echocardiography. Circulation 1985; 72: 1015-21.
20. Heidenreich, R. F. Stainback, R. F. Redberg, N. B et al: Transesophageal echocardiography predicts mortality in critically ill patients with unexplained hypotension J Am Coll Cardiol 1995; 26: 152-8,
21. Savino JS; Troianos CA; Aukburg S et al: Measurement of pulmonary blood flow with transesophageal two-dimensional and Doppler echocardiography Anesthesiology, 1991 : 75:445-51
22. Darmon PL; Hillel Z; Mogtader A; Mindich B et al: Cardiac output by transesophageal echocardiography using continuous-wave Doppler across the aortic valve. Anesthesiology1994; 80:796-805
23. Feinberg MS; Hopkins WE; Davila-Roman VG, et al: Multiplane transesophageal echocardiographic doppler imaging accurately determines cardiac output measurements in critically ill patients. Chest 1995; 107:769-73
24．王伟鹏，张东亚，吴学仁，胡小琴：不同部位放置中心静脉管到位率的观察。中国循环杂志 1995；10：113—114。
25．王伟鹏，刘进，胡盛寿．微创心脏外科及麻醉．微创外科杂志2001，1：39—42。
26．王伟鹏，陈雷，于钦军等：Port-Access心脏手术中的监测微创外科杂志2001，1：
27. Practice guidenlines for perioperative transesophageal echocardiography. A report by the Amerticna Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 1996; 84: 986-1006.
28. Sheikh KH, de Bruijn NP, Rankin JS, et al. The utility of transesopageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery. JACC 1990; 15: 367-72.
29. Sheikh KH, Bengtson JR, Rankin JS, et al. Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation 1991; 84: 594-604.
30. Katz ES, Tunick PA, Rusinek H, et al. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopumonary bypass: experience with intraoperative transesophageal echocardiography. JACC 1992; 20: 70-7.
31．袁定华，李守平，杨浣宜，等．胸主动脉病变术中经食管超声应用初探．中国循环杂志，1996，11(2)：76-78．
32. Flachskampf FA, O'shea JP, Griffin BP, et al. Patterns of Normal Transvalvular Regurgitation in Mechanical Valve prostheses. JACC 1991; 18: 1493-8.
33. Flachskampf FA, Hoffmann R, Franke A, et al. Does multiplane transesophageal echocardiography improve the assessment of prosthetic valve regurgitation? J Am Soc Echocardiogr 1995; 8: 70-8.
34. Yumoto M, Katsuya H: Transesophageal echocardiography for cardiac surgery in children. J of Cardiothoracic and Vascular Anesthesia, 2002; 16:587-91
35．王伟鹏 李立环 常勇男 等：经食管超声心动图在肥厚型梗阻性心肌病手术中的应用．2002年中华医学会全国麻醉学术年会论文摘要汇编．636．南京
36. Stevenson JG, Sorensen GK, Gartman DM, et al. Left ventricular outflow tract obstruction: an indication for intraoperative transesophageal echocardiography. J Am Soc Echocardiogr 1993; 6:525-35
37. Bettex DA, Vogt PR, Jermi R, Schmid ER. Unusual intraoperative impact of transesophageal echocardiography during the correction of a persistent pseudoaneurysm perfused from the left ventricular outflow tract. J Cardiothorac Vasc Anesth 2002; 16:80-82
38. Ashidagawa M, Ohara M, Koide Y. An intraoperative diagnosis of dynamic left ventricular outflow tract obstruction using transesophageal echocardiography leads to the treatment with intravenous disopyramide. Anesth Analg 2002; 94:310-2
39. Reichert CL; Visser CA; Koolen JJ et al: Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters. J Thorac Cardiovasc Surg 1992; 104:321-6
40. Cicek S, et al: Tansesophageal echocardiography in cardiac surgical emergenies. J Card Surg 1995:10:236-44
41. Cook CH et al: Transthoracic echocardiography is not cost-effective in critically ill surgical patients. J Trauma 2002; 52:280-4
42. Sohn DW; Shin GJ; Oh JK et al:Role of transesophageal echocardiography in hemodynamically unstable patients. Mayo Clin Procl995; 70: 925-31
43. Poelaert JI; Trouerbach J; De Buyzere M et al: Evaluation of transesophageal echocardiography as a diagnostic and therapeutic aid in a critical care setting.Chest 1995; 107: 774-9