目的 探讨四维经食管超声心动图（4D-TEE）在瓣膜修复中的作用。 方法 2016 年 1 月我院对 3 例行二尖瓣修复和 1 例行主动脉瓣膜修复的患者采用西门子 SC2000 4D-TEE 进行术前术后评估，其中男 2 例、女 2 例，年龄38～59 （48.0±10.5）岁。同期采用二维经食管超声心动图指导二尖瓣和主动脉瓣修复的 13 例患者作为对照，其中男 8 例、女 5 例，年龄43～67（56.4±7.5）岁。 结果 术中 4D-TEE 可实时显示瓣叶的各项参数，如不同节段瓣叶高度、交界区面积、瓣叶面积、对合面的大小、窦管交界大小，瓣膜运动形态、主动脉管壁位移等信息。可根据内置软件建立个性化的瓣膜几何模型，动态模拟瓣膜启闭并直观呈现。对照组仅可显示某切面的瓣膜、腱索、乳头肌、心腔等信息。 结论 4D-TEE 跳过了对二维图像的解读步骤，更直观完整地显示了瓣膜形态和动态，可以通过它的辅助来进行更有效的手术决策。
Objective To summarize and analyze the surgical approach and early prognosis of repairing adult aortic closure insufficiency with the Florida sleeve procedure. Methods The patients with aortic insufficiency who underwent Florida sleeve repair in the First Hospital of Nanjing Medical University between August 2020 and May 2024 were selected. Their general data, perioperative conditions, and echocardiographic data before, during, and after the procedure and at follow-up were analyzed. Result Fifteen patients were included, consisting of 12 males and 3 females, aged 33-71 (53.5±12.4) years. Preoperative echocardiography indicated that there was 1 patient of rheumatic disease, 7 patients of degenerative disease, 4 patients secondary to aortic aneurysm, and 3 patients of bicuspid aortic valve. The severity distribution included 2 patients of severe insufficiency, 4 patients of moderate-to-severe insufficiency, 5 patients of moderate insufficiency, and 4 patients of mild-to-moderate insufficiency. The mean cardiopulmonary bypass time was (135.0±40.0) minutes, the aortic cross-clamp time was (109.9±38.6) minutes, and the median ICU stay was 1 day. No mortality was recorded within 30 days postoperatively. Follow-up echocardiography showed that the valve regurgitation, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and sinus diameter all achieved the desired outcomes. Conclusion Florida sleeve repair for aortic valve in patients with a sinus diameter less than 50 mm not only effectively improves hemodynamics in adults with aortic insufficiency, but also has the advantages of low surgical risk and rapid postoperative recovery, making it a promising procedure for clinical application.