PDF(Pubmed)
Abstract：
OBJECTIVE: Transesophageal echocardiography (TEE) is considered an indispensable tool for perioperative evaluation in mitral valve (MV) surgery. TEE is routinely performed by anesthesiologists competent in TEE; however, in certain situations, the expertise of a senior cardiologist specializing in TEE is required, which incurs additional costs. The purpose of this study is to determine the indications for specialized perioperative TEE based on its utility and the correlation between intraoperative TEE diagnoses and surgical findings, compared with routine TEE performed by an anesthesiologist.
METHODS: We conducted a three-year prospective study involving 499 patients with MV disease undergoing cardiac surgery. Patients underwent intraoperative and early postoperative TEE and at least one other perioperative echocardiographic evaluation. A computer application was dedicated to calculating the utility of each type of specialized TEE indication depending on the type of MV disease and surgical intervention.
RESULTS: The indications for performing specialized perioperative TEE identified in our study can be categorized into three groups: standard, relative, and uncertain. Standard indications for specialized intraoperative TEE included establishing the mechanism and severity of MR (mitral regurgitation), guiding MV valvuloplasty, diagnosing associated valvular lesions post MVR (mitral valve replacement), routine evaluations in triple-valve replacements, and identifying the causes of acute, intraoperative, life-threatening hemodynamic dysfunction. Early postoperative specialized TEE in the intensive care unit (ICU) is indicated for the suspicion of pericardial or pleural effusions, establishing the etiology of acute hemodynamic dysfunction, and assessing the severity of residual MR post valvuloplasty.
CONCLUSIONS: Perioperative TEE in MV surgery can generally be performed by a trained anesthesiologist for standard measurements and evaluations. In certain cases, however, a specialized TEE examination by a trained senior cardiologist is necessary, as it is indirectly associated with a decrease in postoperative complications and early postoperative mortality rates, as well as an improvement in immediate and long-term prognoses. Also, for standard indications, the correlation between surgical and TEE diagnoses was superior when specialized TEE was used.
METHODS: We conducted a three-year prospective study involving 499 patients with MV disease undergoing cardiac surgery. Patients underwent intraoperative and early postoperative TEE and at least one other perioperative echocardiographic evaluation. A computer application was dedicated to calculating the utility of each type of specialized TEE indication depending on the type of MV disease and surgical intervention.
RESULTS: The indications for performing specialized perioperative TEE identified in our study can be categorized into three groups: standard, relative, and uncertain. Standard indications for specialized intraoperative TEE included establishing the mechanism and severity of MR (mitral regurgitation), guiding MV valvuloplasty, diagnosing associated valvular lesions post MVR (mitral valve replacement), routine evaluations in triple-valve replacements, and identifying the causes of acute, intraoperative, life-threatening hemodynamic dysfunction. Early postoperative specialized TEE in the intensive care unit (ICU) is indicated for the suspicion of pericardial or pleural effusions, establishing the etiology of acute hemodynamic dysfunction, and assessing the severity of residual MR post valvuloplasty.
CONCLUSIONS: Perioperative TEE in MV surgery can generally be performed by a trained anesthesiologist for standard measurements and evaluations. In certain cases, however, a specialized TEE examination by a trained senior cardiologist is necessary, as it is indirectly associated with a decrease in postoperative complications and early postoperative mortality rates, as well as an improvement in immediate and long-term prognoses. Also, for standard indications, the correlation between surgical and TEE diagnoses was superior when specialized TEE was used.
摘要：
目的：经食管超声心动图（TEE）被认为是二尖瓣（MV）手术围手术期评估不可或缺的工具。TEE通常由具有TEE能力的麻醉师进行；但是，在某些情况下,需要专门研究TEE的高级心脏病专家的专业知识，这会产生额外的成本。这项研究的目的是根据其效用和术中TEE诊断和手术发现之间的相关性来确定专门的围手术期TEE的适应症。与麻醉师进行的常规TEE相比。
方法：我们进行了一项为期三年的前瞻性研究，纳入了499例接受心脏手术的MV病患者。患者接受了术中和术后早期TEE以及至少一项其他围手术期超声心动图评估。计算机应用程序专门用于根据MV疾病的类型和手术干预来计算每种类型的专门TEE适应症的效用。
结果：在我们的研究中确定的进行专门的围手术期TEE的适应症可以分为三组：标准，相对，和不确定。术中专门TEE的标准适应症包括确定MR（二尖瓣反流）的机制和严重程度，引导MV瓣膜成形术，MVR（二尖瓣置换术）后诊断相关瓣膜病变，三瓣膜置换的常规评估，并确定急性的原因，术中,危及生命的血流动力学功能障碍。重症监护病房（ICU）的早期术后专业TEE适用于怀疑心包或胸腔积液。建立急性血流动力学功能障碍的病因，并评估瓣膜成形术后残余MR的严重程度。
结论：MV手术的围手术期TEE通常可以由训练有素的麻醉师进行标准测量和评估。在某些情况下,然而,由训练有素的高级心脏病专家进行专门的TEE检查是必要的，因为它与术后并发症和术后早期死亡率的降低间接相关，以及近期和长期预后的改善。此外，对于标准适应症，当使用专门的TEE时,手术和TEE诊断之间的相关性更好.
方法：我们进行了一项为期三年的前瞻性研究，纳入了499例接受心脏手术的MV病患者。患者接受了术中和术后早期TEE以及至少一项其他围手术期超声心动图评估。计算机应用程序专门用于根据MV疾病的类型和手术干预来计算每种类型的专门TEE适应症的效用。
结果：在我们的研究中确定的进行专门的围手术期TEE的适应症可以分为三组：标准，相对，和不确定。术中专门TEE的标准适应症包括确定MR（二尖瓣反流）的机制和严重程度，引导MV瓣膜成形术，MVR（二尖瓣置换术）后诊断相关瓣膜病变，三瓣膜置换的常规评估，并确定急性的原因，术中,危及生命的血流动力学功能障碍。重症监护病房（ICU）的早期术后专业TEE适用于怀疑心包或胸腔积液。建立急性血流动力学功能障碍的病因，并评估瓣膜成形术后残余MR的严重程度。
结论：MV手术的围手术期TEE通常可以由训练有素的麻醉师进行标准测量和评估。在某些情况下,然而,由训练有素的高级心脏病专家进行专门的TEE检查是必要的，因为它与术后并发症和术后早期死亡率的降低间接相关，以及近期和长期预后的改善。此外，对于标准适应症，当使用专门的TEE时,手术和TEE诊断之间的相关性更好.
