Objective To investigate the use of intraoperative transesophageal echocardiography( IOTEE ) in the diagnosis and treatment of aorto left ventricular tunnel( ALVT ). Methods Seven patients diagnosed as aorto left ventricular tunnel were monitored by intraoperative transesophageal echocardiography before and right after the surgical procedures including 4 patients with congenital aorto left ventricular tunnel and 3 patients with acquired aorto left ventricular tunnel( 2 cases of abnormal traffic between left ventricular and the aorta side of the aortic valve after aortic valve replacement, combined with mechanical valve paravalvular leakage; 1 case of residual shunt after repairment of ventricular septal defect, abnormal traffic between aortic and left ventricular, combined with aortic valve perforation ). All the 7 cases were peformed transesophageal echocardiography immediately before and after cardiopulmonary bypass to comprehensive evaluate the morphology of aortic-left ventricular abnormal channel, the involvement of the aortic valve, the mechanical aortic valve periprosthetic leakage and the structure and function surrounding the ascending aorta. Results All the 7 aorto left ventricular tunnels were described by IOTEE , including the position, the diameters and orifices of the tunnels. Two cases combined with expansion of the ascending aorta. One case of poor development of the none and left coronary valve, with small aortic valve regurgitation. One aortic valve perforation patient with large aortic valve regurgitation. Two mechanical vavle paravalvular leakage patients with small amount of reflux. All the 7 patients were operated, including simple closure of the tunnel and aortic valvuloplasty or replacement. IOTEE performed before the operation made the aorto left ventricular tunnel diagnosis accurate and helped choose the suitable surgical procedure. After the operations, the closure of the tunnel and the aortic valve sufficiency were evaluated by the transesophageal echocardiography. Conclusion The intraoperative transesophageal echocardiography is a reliable technique, and it makes great contribution to the accurate diagnosis and suitable treatment for aorto left ventricular tunnel.%目的 探讨及总结经食管超声心动图在主动脉-左心室异常通道诊断及治疗中的应用价值.方法 回顾性分析7例主动脉-左心室异常通道患者,包括先天性主动脉-左心室隧道4例,获得性主动脉-左心室异常通道3例,包括主动脉瓣置换术后主动脉瓣旁的主动脉与左心室间的异常交通合并机械瓣瓣周漏2例,室间隔缺损修补术后残余分流、主动脉与左心室异常交通合并主动脉瓣穿孔1例.7例患者体外循环前后均即刻行经食管超声心动图检查,全面评价主动脉-左心室异常通道的形态,主动脉瓣受累情况、机械瓣瓣周漏情况及升主动脉等周边结构的形态及功能.结果 7例患者术中经食管超声均正确诊断,并准确显示7例主动脉-左心室异常通道的交通口位置、直径、隧道宽度、长度、走形及与邻近结构关系等解剖信息.2例患者合并升主动脉扩张.1例主动脉瓣无冠瓣和左冠瓣发育欠佳,主动脉瓣少、中量反流,1例主动脉瓣穿孔患者主动脉瓣中大量反流.2例机械瓣瓣周漏患者瓣周少、中量反流.手术包括单纯闭合主动脉-左心室隧道、主动脉瓣位机械瓣置换、主动脉瓣成形等.术后经食管超声心动图即刻评价主动脉-左心室异常通道的闭合情况、主动脉瓣机械瓣的功能、成形术后自体主动脉瓣的功能,保证了手术效果.结论 术中超声心动图能为外科医师提供主动脉-左心室异常通道及周边结构受累的详细解剖及功能信息,并可及时、准确地评价通道闭合情况和主动脉自体瓣或机械瓣功能等手术效果.
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