超声心动图监测在先心病介入封堵术中的临床意义

Clinical Effect of Echocardiography in Supervising Congenital Heart Disease

【目的】探讨超声心动图在监测先天性心脏病封堵术中的临床意义。【方法】先心病患者66例，男41例，女25例。其中房间隔缺损（ASD）34例、室间隔缺损（VSD）17倒、动脉导管未闲（PDA）15例。经胸超声心动图（TTE）监测66例，其中同时经食管超声心动图（TEE）监测24例。观察缺损类型、大小、形态，引导封堵伞堵放置，封堵后即刻评价效果及并发症。术后TTE随访。【结果】60例患者封堵成功，ASD患者中4例封堵失败，VSD患者中2例封堵失败。所有失败病例均及时改行体外循环修补。封堵成功患者随访6～12个月效果满意。【结论】TEE可弥补部分患者中TTE图像分辨率的不足，准确观测各种先天性心脏缺损的大小、形态以及周边结构，指导封堵器的选择和释放，评价疗效，在先天性心脏病缺损封堵术中发挥重要作用。

[Objective] To discuss the clinical value of echocardiography （TTE and TEE） in supervising congenital heart defect closure. [Methods] Studies were performed on 66 patients including 41 male and 25 female. Thirty four patients with atrial septal defect（ASD）, 17 patients with ventricular septal defect（VSD） and 15 patients with patent ductus arteriosus（PDA） were involved. All these cases were examined by transthoracic echocardiography（TTE） and 24 cases examined by transesophageal echocardiography（TEE） at the same time. Echocardiography was used to confirm the type, size and shape of defects before surgery,and to guide and monitor the whole occlusion process,and to evaluate operative effect instantly during operation. All cases were follow up by TTE in 6- 12m after transcatheter occlusion. [Results] Satisfactory occlusion device implantation was achieved in 60 subjects. The failure patients included 4 ASD and 2 VSD. All failure cases were turned to open thoracic operation. The result was satisfied after 6- 12 mouths follow-up survey. [Conclusion] TEE plays a very important role in performing transcatheter closure of cardiac defect, which can accurately evaluate the defect diameter, shape and peripheral structure, and can also guide occluder delivery and evaluate the occlusion effect.