经食管超声心动图在风湿性心脏病及合并症介入治疗中的应用

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1、经食管超声心动图在风湿性心脏病及合并症介入治疗中的应用伦知见[摘要]目的经食道超声心动图（TEE）可清晰显示左心房及心耳部轮廓及其内的血流情况，能确切判定左心房及心耳部血栓的精确部位、大小、形状、附壁状态、有无活动度。能正确评估风湿性二尖瓣及其它瓣膜病变损害的程度，对术前判定二尖瓣球囊瓣膜成形术（PBMV）的适应症及在左心房存在血栓条件下的PBMV具有重要的应用价值。方法术中在TEE监视引导下，引导导丝和导管避开左心耳及附近左房壁的血栓，即刻评定球囊扩张的效果，预防并发症的发生。结果在左房及耳部存在机化性血栓、直径（φ）≤1.0cm的左

2、心耳孤立性低回声宽基底的附壁血栓,行PBMV术未出现栓塞并发症；房间隔缺损伴风心病二尖瓣狭窄（Lutembacher综合征）先行PBMV术，后用Amplatzer伞对房间隔缺损进行封堵获得成功。对妊娠合并风湿性二尖瓣狭窄、老年性风湿性二尖瓣狭窄行PBMV术，疗效满意。结论TEE为PBMV在术前适应症的判定及术中提供了新的监测手段，在左房存在血栓条件下，使PBMV术由禁忌症变成相对适应症，缩短了病程，提高了介入性手术治疗的安全性、精确性和成功率。[关键词]经食管超声心动图描记术；左心房；血栓；二尖瓣球囊瓣膜成形术．Applicationo

3、ftransesophagealechocardiographyguidedinterventionaltherapyinpatientswithrheumatoidheartdiseaseandcomplicationsLunZhi-jianYishuiCentralHospital,Linyi,Shandong276400,China【Abstract】ObjectiveTheexactposition,size,character,stickinessandmovementofleftatrialthrombicanbejudge

4、dbyuseoftransesophagealechocardiography(TEE)whichcanshowtheprofileoftheleftatrialappendageandtheflowinit.WeobservedtheusefulnessofTEEinpercuteneousballoonmitralvalvuloplasty(PBMV)inpatientswithmitralstenosisandthrombiintheleftatrialappendage.MethodsTEEprovidesaliveandcle

5、arplanarpictureshowingtheatrialseptum,punctureneedleandthedilatationoftheballooncatheter.Theguidewireandcatheterwerekeptawayfromatrialthrombiintheintervenientprocedureavoidingofthrombus.ResultsNothrombosiswerefoundinpatientswithorganizationthrombusintheleftatriumorleftat

6、rialappendageinPBMV,nonewerefoundinthosewithisolatedlow-echoedthrombi(φ≤1.0cm)intheleftatrialappendage.AtralseptaldefectwasclosedsuccessfullywithAmplatzerSeptalOccluderafterPBMVin1caseofLutembacher'sSyndrome.ToPregnancywithrheumatoidmitralstenosisandSenilerheumatoidmitra

7、lstenosis,PBMVhasgoodcurativeeffect.ConclusionsApplicationofTEEcanimprovethesafety,accuracyandhealingrateinPBMVandconverttheforbiddanceintorelativeapplicationinpatientswithleftatrialthrombi.【Keywords】Echocardiographytransesophageal;Leftatrium;Thrombus;Percutaneousballoon

8、mitralvavuloplasty.二尖瓣球囊瓣膜成形术（PBMV）是一种创伤小、疗效肯定及较安全的介入性治疗法，本文旨在（TEE）术前正确评估风湿性二尖瓣及其它瓣膜病变损害的程度，准确判定二尖瓣球囊瓣膜