实时三维超声心动图引导室间隔缺损封堵术

Application of real-time 3-dimensional echocardiography in guiding closure of ventricular septal defect

目的探讨应用实时三维超声心动图(RT-3DE)独立引导室间隔缺损(VSD)封堵术心内操作部分的可行性.方法对28例膜周部VSD患者在X线引导下分别经股动脉和股静脉插入导管及钢丝,导管及钢丝到达心腔后,操作完全脱离X线,采用RT-3DE独立引导导管在心内的操作和封堵器的释放.术后经X线及RT-3DE检测封堵效果.结果 28例患者均一次封堵成功,术后无残余分流、心律失常、心包填塞、封堵器脱落及栓塞等并发症发生.术后6 h患者均可自由活动,1～2 d出院.随访1～3个月,超声心动图检查无残余分流,封堵器位置良好.结论采用RT-3DE独立引导VSD封堵术心内部分操作是可行的,且减少了整个手术过程中放射线的使用剂量.

Objective To evaluate the feasibility of real-time 3-dimensional echocardiography （RT-3DE） in independently guiding closure of ventricular septal defect （VSD）, and to compare RT-3DE alone with 2-dimensional echocardiography （2-DE） combined with X-ray in guiding the operation. Methods This study included 28 patients with perimembranous VSD. In them, under the guidance of X-ray, the catheter and steel wire were inserted, via femoral artery and femoral vein, into cardiac chamber. Just when the catheter and wire arrived at the heart, instead of X-ray guidance, RT-3DE was used for guiding the procedure and release of the occluder. After procedure the outcome of the closure was examined by X-ray and RT-3DE. Results The procedure was performed successfully in all the 28 patients. They could act freely 6 hours immediately after the operation, and were discharged from the hospital in 1 or 2 d. No complications such as remnant shunting, arrhythmia, cardiac tamponade, embolism and shedding of the occluder occurred. Follow-up lasted 1 to 3 months, no remnant shunting could be found, and the occluders were in right position on echocardiography. And the size of right atrium and right ventricle was reduced to some extent. Conclusions RT-3DE can guide closure of VSD independently in cardiac chamber. This method has the advantage of displaying the 3-dimensional structure of VSD and the process of the procedure at real time; moreover, both the patients and doctors are exposed to less X-ray radiation.