Application of perioperative multimodality echocardiography in coronary artery bypass grafting surgery
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摘要: 目的 探讨围术期多模态超声心动图在冠状动脉旁路移植术(CABG)中的应用价值。方法 对接受CABG手术的患者在围术期运用超声造影技术评价术前及术后的心肌灌注；同时运用实时三维超声心动图收集各研究对象术前及术后的左室全容积图像，评价左室收缩功能；超声造影检查及实时三维超声检查于术前5~7 d、术后7~12 d内完成。通过术中经食管超声心动图对二尖瓣功能恢复情况的实时监测，辅助临床决策及时调整手术方案。结果 28例接受CABG手术的患者在围术期进行了超声造影检查、实时三维超声检查、术中经食管超声检查。术后心肌灌注参数A值、β值、A×β值、实时三维超声测量左室射血分数较术前改善，差异有统计学意义(P < 0.05)；术后即刻经食管超声心动图诊断轻度二尖瓣反流13例，轻-中度二尖瓣反流12例，中度二尖瓣反流3例(外科予以换瓣)。结论 围术期多模态超声心动图新技术应用于接受CABG患者的心肌灌注心功能评估以及术中辅助治疗策略，具有重要的应用价值。
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关键词:
- 经食管超声心动图，三维 /
- 围术期 /
- 冠状动脉旁路移植术
Abstract: Objective This study investigates the role of perioperative multimodality echocardiography in coronary artery bypass grafting(CABG) surgery.Methods Patients undergoing CABG surgery were assessed using ultrasonic contrast imaging technology to examine myocardial perfusion pre-and post-operation. Real-time three-dimensional echocardiography(RT-3DE) was employed to capture left ventricular full-volume images, evaluating left ventricular systolic function. Additionally, intraoperative transesophageal echocardiography was utilized to monitor real-time mitral valve recovery, enabling on-the-spot clinical decision-making and surgical plan adjustments as needed.Results Twenty-eight CABG patients underwent ultrasonic contrast examination, RT-3DE, and intraoperative transesophageal echocardiography. Post-surgery, improvements were noted in postoperative myocardial perfusion time-intensity curve and left ventricular systolic function measured by RT-3DE compared to pre-surgery, with statistically significant differences(P < 0.05). Transesophageal echocardiography immediately diagnosed thirteen cases of mild mitral regurgitation, twelve cases of mild-to-moderate regurgitation, and three cases of moderate regurgitation, prompting surgical valve replacement.Conclusion Perioperative multimodality echocardiography presents significant utility in evaluating myocardial perfusion, assessing cardiac function, and facilitating intraoperative treatment strategies for patients undergoing CABG surgery. -
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表 1 CABG手术前后左心室心肌造影灌注参数
Table 1. Left ventricular myocardial perfusion parameters before and after CABG surgery
X±S 参数 例数 术前 术后 P值 A值/dB 28 4.98±0.57 7.93±0.41 < 0.001 β值/s-1 28 0.21±0.02 0.28±0.04 0.001 A×β值/(dB/s) 28 1.26±0.11 2.54±0.10 < 0.001 
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表 2 RT-3DE检查参数
Table 2. Parameters of real-time three-dimensional ultrasound examination
X±S 参数 例数 术前 术后 P值 LVEDV/mL 28 118.59±17.24 90.21±15.41 < 0.001 LVESV/mL 28 39.66±16.32 30.18±14.61 < 0.001 LVEF/% 28 53.26±10.65 62.54±10.39 0.002
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表 3 术中经食管超声心动图检查二尖瓣反流程度
Table 3. Transesophageal echocardiography examined the degree of mitral regurgitation during operation
例 反流程度 轻度 轻-中度 中度 中-重度 术前(28例) 4 17 7 0 术后(28例) 13 12 3 0
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[1] Lee ML, Chen TH, Huang HD, et al. Mitral valve repair versus replacement in patients with ischemic mitral regurgitation[J]. J Thorac Dis, 2018, 10(5): 2820-2828. doi: 10.21037/jtd.2018.04.93
[2] Yin L, Wang Z, Shen H, et al. Coronary artery bypass grafting versus combined coronary artery bypass grafting and mitral valve repair in treating ischaemic mitral regurgitation: a meta-analysis[J]. Heart Lung Circ, 2014, 23(10): 905-912. doi: 10.1016/j.hlc.2014.03.031
[3] Zhan J, Zhong L, Wu J. Assessment and treatment for coronary microvascular dysfunction by contrast enhanced ultrasound[J]. Front Cardiovasc Med, 2022, 9: 899099. doi: 10.3389/fcvm.2022.899099
[4] Cotter B, Raisinghani A, DeMaria AN. Established and emerging roles for ultrasound enhancing agents(contrast echocardiography)[J]. Clin Cardiol, 2022, 45(11): 1114-1122. doi: 10.1002/clc.23924
[5] Main ML, Fu JW, Gundrum J, et al. Impact of contrast echocardiography on outcomes in critically ill patients[J]. Am J Cardiol, 2021, 150: 117-122. doi: 10.1016/j.amjcard.2021.03.039
[6] Alherbish A, Becher H, Alemayehu W, et al. Impact of contrast echocardiography on accurate discrimination of specific degree of left ventricular systolic dysfunction and comparison with cardiac magnetic resonance imaging[J]. Echocardiography, 2018, 35(11): 1746-1754. doi: 10.1111/echo.14152
[7] Spitzer E, Ren B, Zijlstra F, et al. The role of automated 3D echocardiography for left ventricular ejection fraction assessment[J]. Card Fail Rev, 2017, 3(2): 97-101. doi: 10.15420/cfr.2017:14.1
[8] Cai Q, Wang J, Li H, et al. Measurement of left ventricular volumes and ejection fraction in patients with regional wall motion abnormalities using an automated 3D quantification algorithm[J]. Ultrasound Med Biol, 2018, 44(11): 2274-2282. doi: 10.1016/j.ultrasmedbio.2018.07.015
[9] Medvedofsky D, MorAvi V, Amzulescu M, et al. Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics algorithm: multicentre validation study[J]. Eur Heart J Cardiovasc Imaging, 2018, 19(1): 47-58. doi: 10.1093/ehjci/jew328
[10] Sun L, Feng H, Ni L, et al. Realization of fully automated quantification of left ventricular volumes and systolic function using transthoracic 3D echocardiography[J]. Cardiovasc Ultrasound, 2018, 16(1): 2. doi: 10.1186/s12947-017-0121-8
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