超声心动图对不同类型室间隔缺损封堵适应证选择的研究

Study on indicational selection in different types of ventricular septal defect occlusion by echocardiography

目的 探讨不同类型室间隔缺损(VSD)经导管封堵术适应证的超声心动图选择标准。方法 术前应用超声心动图确定VSD类型、大小、形态,缺损距瓣膜距离,彩色多普勒血流显像(CDFI)观测 VSD分流情况;术中指导封堵器的释放及发现早期并发症或术后并发症。结果 成功封堵单纯膜部或膜周型、嵴内型和肌型VSD患者 221 例,封堵未成功者 12 例。术前超声检出膜部 VSD 209 例,左室侧舒张期最大径(7.1±3.7)mm;右室侧多孔140例,其中最大孔径为(3.6±1.1)mm;CDFI测定VSD分流宽度(7.2±3.6)mm;VSD残端距主动脉瓣距离(2.8±2.4)mm,距三尖瓣距离(3.2±2.6)mm。嵴内 VSD 9 例,大小(7.8±1.6)mm;VSD分流宽度(8.8±1.1)mm。肌型VSD 3例,大小分别为 9 mm,10 mm及6 mm。术后24 h有4例出现残余分流伴溶血。封堵术未成功者超声显示膜部VSD右室侧多孔 6 例,最大孔径<2 mm 5 例,>2 mm 1 例,缺损口左、右室侧大小相似2例;嵴内型和肌型各2例,封堵术中出现Ⅲ度房室传导阻滞及明显的主动脉瓣反流而放弃封堵术。结论 超声心动图能在术前准确判定 VSD类型、大小、形态、缺损残端与瓣周距离等,选择 VSD封堵术最佳适应证,并于封堵术后观察疗效。

Objective To study the inclusion criteria of occlusion indication by echocardiography for different ventricular septal defect(VSD) occlusion.Methods Before occlusion,the diameter and the type of VSD,the distance from VSD to aortic valve,tricuspid valve and pulmonary valve were measured,meanwhile,the shunt was observed by color Doppler flow imaging (CDFI).Occlusion of VSD was directed and complications were found by echocardiography in the operation or after the operation.Results Before occlusion,echocardiography showed that the largest diastolic size of perimembranous VSD in left ventricle side of 209 patients were ( 7.1± 3.7)mm,and the largest pore size were ( 3.6± 1.1)mm of the 140 patients whose right ventricle side of VSD were porosity.The widths of VSD shunt measured by CDFI were ( 7.2± 3.6)mm.The distance from VSD to aortic valve was ( 2.8± 2.4)mm and to tricuspid valve was ( 3.2± 2.6)mm.The size of VSD was ( 7.8± 1.6)mm in 9 patients with intracristal VSD,and the width of shunt was ( 8.8± 1.1)mm.In the 3 patients with muscular VSD,the size was 9 mm,10 mm and 6 mm,respectively.Four remnant shunt with hemolysis were found 24 hours later after operation.Two hundred and thirty-three patients with different types of VSD were occluded,including 12 patients failed.Six patients were porosity in right ventricle side of perimembranous VSD,in which the largest pore size was less than 2 mm in 5 patients.Operations were given up for 2 cases of muscular VSD,because third degree atrioventricular block occurred if the occluder was too close to the VSD.The right coronary artery valve prolapsed with 2 intracristal VSD.They were also given up occlusion for aortic regurgitation apparently.Conclusions The best indication must be chosen by echocardiography to ensure VSD occlusion successfully and the better prognostic efficacy.