探讨经食管超声心动图引导经胸微小切口封堵主动脉-中国循环杂志.pdfVIP

中国循环杂志 2018 年 4 月 第 33 卷 第 4 期（总第 238 期）Chinese Circulation Journal，April，2018，Vol. 33 No.4（Serial No.238） 371 临床研究 探讨经食管超声心动图引导经胸微小切口封堵主动脉夹层的可行性 王小锋，聂芳，叶娜，刘学会，杨绍庆 摘要 目的 : 探讨术中经食管超声心动图（TEE）引导经胸微小切口封堵主动脉夹层的可行性。 方法：2 例主动脉夹层患者术前行 TEE 检查，并与经胸超声心动图（TTE）检查结果进行对比，明确术前诊断并作 定量评估，术中准确引导导丝及鞘管顺利进入夹层破口，评估封堵伞的位置、稳定性及对局部血流的影响。 结果：2 例患者经 TEE 检查确定可以进行介入封堵治疗，并在 TEE 引导下成功封堵主动脉夹层破口。病例 1 是 DeBakey II 型主动脉夹层，封堵后破口分流消失，假腔形成血栓，内径由 40 mm 缩小为 28 mm，管径回缩约 40%；病 例 2 是主动脉弓部溃疡型夹层，封堵器与主动脉管壁切合紧密，封堵器伸展良好，破口分流消失，主动脉弓部局部 血流速度封堵前后均约 110 cm/s，无明显变化，未见狭窄及局限性扩张。术后 1 个月 TTE 复查，2 例患者的封堵器位 置正常。 结论：TEE 能有效地对主动脉夹层术前检查确诊，弥补和纠正漏诊或错误，为术者提供直观的图像及有关的定量 信息，引导术者准确放置封堵器，及时对手术效果进行准确评估，TEE 引导经胸微小切口封堵部分主动脉夹层破口 是一种可行的介入治疗主动脉夹层的方法。 关键词 超声心动描记术，经食管；主动脉夹层；介入治疗 Feasibility of Aortic Dissection Occlusion via Mini-thoracotomy by Trans-esophageal Echocardiography Guidance WANG Xiao-feng, NIE Fang, YE Na, LIU Xue-hui, YANG Shao-qing. Department of Ultrasound, The Second Hospital of Lanzhou University, Lanzhou (730030), Gansu, China Corresponding Author: NIE Fang, Email: fang-nie@163.com Abstract Objectives: To explore the feasibility of aortic dissection (AD) occlusion via mini-thoracotomy by trans-esophageal echocardiography (TEE) guidance. Methods: Pre-operative TEE was conducted in 2 AD patients, the findings were compared with trans-thoracic echocardiography (TTE) to confirm the diagnosis with quantitative evaluation in order to accurately guiding the wire and sheath pipe into the rupture crevasse of AD for assessing the position, stability and the effect of closure device on local blood flow. Results: TEE confirmed that 2 patients could be treated by interventional plugging and the crevasses of AD were successfully blocked by TEE guidance. Case 1 had DeBakey II AD, crevasse shunt disap