超声心动图导引下介入治疗室间隔缺损

Interventional closure of ventricular septal defect under the guidance of transthoracic echocardiography

目的 研究体表超声 (TTE)导引介入治疗室间隔缺损 (VSD)的临床意义。方法 5 7例膜部VSD ,18例合并膜部室间隔膨出瘤 ;5例肌部VSD ,其中 1例为多发性 ,1例为心肌梗死所致室间隔穿孔 ,1例合并膜部室缺。缺损直径 2～ 16mm。在TTE引导下 ,采用 4～ 18mm封堵伞进行经导管介入封堵。结果 TTE明确诊断 62例VSD ,准确率 10 0 %。 61例VSD介入治疗成功 ,成功率 98.4%。术后 5 1例左向右分流束消失 ,10例残余少量左向右分流 ,其中 6例合并主动脉瓣轻度关闭不全 ,4例合并轻度二、三尖瓣关闭不全。结论 TTE导引在VSD封堵术中确定适应证 。

Objective To investigate the clinical significance of ventricular septal defect (VSD) closure under the guidance of transthoracic echocardiography (TTE). Methods A total of 62 patients including 28 males and 34 females, aged from 3 to 75 years (mean 14.2±6.9 years) underwent TTE, right catheterization and left ventricular angiography. Membranous VSDs were found in 57 cases, of whom 18 patients had protruded membranous aneurysm, other 5 were confirmed with muscular VSDs, 2 cases had multiple VSDs, 1 had VSD after perforation of myocardial infarction and 1 had membraneous VSDs. The defect size ranged from 2 to 16 mm, and was occluded with umbrella devices with size of 4 to 18 mm. HP-Sonos 1500 and Toshiba PV 6000 with probe frequency 2.5-3.75 MHz were respectively used in TTE to measure VSDs and great vessel diameters to observe shunts, valves and VSDs location on left parasternal long axis, great artery short axis, four chamber, apical four chamber and five chamber views. Results VSDs were successfuly occluded in 61 of 62 patients (98.4%). TTE could definitely diagnose 100% of VSDs. In 51 of 62 patients, an effective closure was obtained. Slight residual shunt was found in 10 patients, with mild artic regurgition in 6 and mild mitral and tricuspid incompetence in 4 patients. Conclusion TTE guidiance is essential for defining the indications and preventing operational complications during interventional therapy of VSD. [