超声心动图在经导管封堵主动脉窦瘤破裂中的作用

Function of echocardiography in transcatheter closure of ruptured sinus of valsalva aneurysm

目的对超声心动图主动脉窦瘤破裂(RSVA)介入治疗中的作用进行归纳分析。方法3例本单位和37例散在报道的RSVA封堵资料,年龄7～74岁,女21例,男19例。归纳分析超声心动图在RSVA封堵的术前诊断,术中引导监护,术后随访方面的规律和特点。结果术前超声心动图对37例RSVA作出了正确诊断。2例误诊,1例漏诊。40例RSVA位于右冠窦31例,位于无冠窦9例。其中两例为多发破孔。位于右冠窦者多破入右室,位于无关窦者多破入右房。RSVA破口直径2～12 mm不等。术中均需超声心动图引导监护,7例采用经食管超声心动图;其余采用经胸超声心动图。多数根据超声与造影测量的破口直径毫米数+1～4选用封堵器型号,需要注意术中当导管/鞘管通过破口后,超声所测直径较术前可能有不同程度增加。40例患者采用动脉导管未闭封堵器30个,室间隔缺损封堵器4个,Rashkind伞3个,Coil弹簧圈2个,房缺封堵器2个。封堵即刻超声心动图在少量残余漏与主动脉瓣反流的鉴别方面优于心血管造影。术后随访依赖超声心动图。1例因少到中量残余漏合并溶血而转外科手术,1例因进行性心衰死亡。余38例效果良好未见并发症。结论在熟练掌握VSD、PDA介入治疗基础上,可成功开展RASA封堵治疗。超声心动图在RSVA封堵术前是诊断和鉴别诊断RSVA的首选方法;在术中有助于更准确选择封堵伞型号;在封堵后即刻辨别残余漏和主动脉瓣反流优于心血管造影。

Objective To sum up the function of echocardiography in transcatheter closure of ruptured sinus of valsalva aneurysm （RSVA）. Methods Forty RSVA patients closured by transcatheter intervention, in which 3 cases came from our hospital, other 37 cases came from the dispersive reported. Age 7-74 years old. Male 19, female 21. Sumed up and analysed the function of echocardiography before, during and after RSVA closure procedure. Results Before the operation, 37 patients gained correct diagnosis by two-dimensional and color Doppler echocardiography, 2 were misdiagnosed and 1 was missed diagnosis. The echocardiography revealed that there were 31 RSVA located at right coronary sinus and 9 at noncoranary sinus. In the former most of crevasses breaked into right ventricle and in the later most of crevasse breaked into right atrium. The estimated size of the aortic opening site of the RSVA was 2-12 mm. During closure procedure needed echocardiography for guiding and monitoring in all of cases, 7 with transesophageal echocardiography （TEE） and 33 with transthoracic ehcocardiography （TTE）. In most patients the sizes of the occluder were chosen to be at least 1 to 4 mm larger than the maximal diameter of the opening sites as measured by echocardiography or angiocardiography. It should be noted that after catheter or sheath passing through the opening site, the diameter of the rupture orifice may be larger than that earlier echocardiography measured. There were 30 Amplatzer duct occluder, 4 ventricular septal occluder, 3 Rashkind umbrella, 2 Gianturco coil and 2 atrium septal occluder were deployed. Immediately after occluding RSVA echocrcardiography had an advantage in assessment of closure effect, particularly in distinguishing residual shunt from aortic valve regurgitation. Following up mainly depends on echocardiography. After intervention 1 case had residual shunt developed hemolysis and was sent for surgical repair. 1 case died of progressive congestive heart failure. Other 38 patients were asymptomatic and no complications. Conclusion Transcatheter closure RSVA could be successful on the base of skillful doing intervention treatment of VSD and PDA. Before the intervention, echocardiagraphy is the preferred diagnosis modality. During intervention, echocardiagraphy is helpful for selecting the size of occluder more accurate. Immediately after intervention, echocardiagraphy excels angiography at distinguishing residual shunt from aortic valve regurgitaion.