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目的评价经食道超声心动图(TEE)在肺动脉闭锁合并室间隔完整(PA/IVS)外科治疗中的应用价值。方法 79例PA/IVS为研究对象,分别在手术前、后行TEE检查。结果 2例患儿体外循环前经TEE确诊心肌窦样间隙开放而改变治疗方案。36例行双心室修复术,5例术后TEE证实肺动脉前向血流少,其中4例加行B-T术,1例加行Glenn术。11例行1心室修复患儿中,1例Glenn吻合口,1例B-T管道血流显示不清,但因患儿血流动力学稳定,未进行二次转流。15例行B-T术患儿,6例术后TEE示B-T血流显示不清,其中2例再行B-T分流术。10例行Glenn手术,1例因术后TEE示腔肺吻合口狭窄再行腔肺分流术。7例行Fontan手术,1例术后TEE示二尖瓣中度反流,再行二尖瓣整形。结论 TEE是一种安全、有效、实用的监测手段,值得在肺动脉闭锁合并室间隔完整外科治疗中推广应用。
Objective To evaluate the value of transesophageal echocardiography (TEE) in the surgical treatment of pulmonary atresia complicated with interventricular septum integrity (PA / IVS). Methods 79 cases of PA / IVS as the research object, respectively, before and after surgery TEE examination. Results 2 cases of children before cardiopulmonary bypass TEE-confirmed open sinus osseous space to change the treatment program. Thirty-six patients underwent biventricular repair, and 5 postoperative TEE confirmed that the anterior pulmonary blood flow was less. Among them, 4 patients underwent B-T surgery and 1 patient underwent Glenn’s surgery. Of the 11 children with 1-ventricular remodeling, 1 had a Glenn anastomosis and 1 had a B-T duct with unclear blood flow, but no secondary diversion occurred because of hemodynamically stable children. Totally, B-T blood flow was unclear in 15 cases of B-T and 6 cases of postoperative TEE. B-T shunt was performed in 2 cases. Ten patients underwent Glenn operation, and one patient underwent TEE to demonstrate anastomotic and stenosis. Seven patients underwent Fontan operation. One patient underwent postoperative TEE showing moderate mitral regurgitation, followed by mitral valvuloplasty. Conclusion TEE is a safe, effective and practical monitoring method, which is worthy of promotion and application in the complete surgical treatment of pulmonary atresia and ventricular septum.