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.%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shunt disappeared upon blocking, false lumen formed thrombosis, the diameter reduced form 40 mm to 28 mm and the cavity was retracted about 40%. Case 2 had the ulcer type AD located in aortic arch, closure device was closely suit to aortic wall, spread well and crevasse shunt disappeared;blood flow in aortic arch was about 110 cm/s which was similar at pre- and post-operation, no vascular stenosis and local dilatation were found, vital sign was stable. Follow-up TTE was performed at 1 month after the operation which showed the position of closure devices were normal in both patients. Conclusions: TEE could effectively confirm pre-operative AD diagnosis and provide intuitive image and quantitative information for accurately guiding closure position and evaluating surgical result. Mini-thoracotomy with TEE guidance is feasible for interventional therapy of AD.
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