膜周部室间隔缺损经导管封堵治疗中超声心动图的应用价值

Clinical Studies of Echocardiographic Guidance in Transcatheter Closure of Perimembranous Ventricular Septal Defect

目的:探讨超声心动图技术在膜周部室间隔缺损经导管封堵术(TCVSD)中的应用价值。方法:我院拟行室问隔缺损(VSD)封堵术100例患者,术前经胸超声心动图诊断筛选病例,多部位多切面探查,精确测量VSD大小及周边残端长度,封堵术中以经胸超声心动图或经食管超声心动图(3例)实时全程监测心功能及血流动力学变化,引导封堵术的操作过程,术后24小时、1个月、3个月、6个月复查经胸超声心动图随访评价疗效。结果:4例术中放弃封堵,5例封堵失败,共91例封堵成功,技术成功率94.8%(91/96)。83例即时完全封堵(室水平分流完全消失),即时完全封堵率91.2%,8例(8.8%)术后少量残余分流,随访1年后仅1例仍存在少量残余分流。左心房、左心室内径及容积指数术后明显减小,随访中无封堵器移位脱落、瓣膜穿孔关闭不全、感染性心内膜炎、血栓形成等严重并发症。结论:严格地选择病例和封堵VSD近、中期疗效良好。超声心动图在TCVSD术前筛选病例、术中指导操作和及时评价疗效过程中起着重要作用,可以提高TCVSD的安全性和成功率,减少并发症。

Objective ：To explore the value and method of eehoeardiographie guidance in transeatheter closure of perimembranous ventricular septal defect（VSD）. Methods ： From November 2002 to November 2004,100 patients underwent attempted transcatheter closure of a perimembranous VSD, （ male 43, female 57, aged from 3 to 48115. 6 ± 11.2 ] years ）. Patients were selected by transthoraeie eehoeardiography （ TTE ） before intervention therapy. Multi-position and multi-plane examinations were performed to precisely measure the diameters of the defects and their surrounding rims. The closure of VSD was monitored and guided by TTE or transesophageal echocardiography（ in 3 cases） all throughout the procedure. Patients were followed up at 24 hours, 1,3, and 6 months after the procedure. Results：The VSD occluders were successfully implanted in 91 cases with a successful rate of 94. 8 % （91/96 ） , while 5 cases failed and 4 cases were abandoned. Complete closure was achieved in 83 eases（91.2% ）. Mild residual shunt（ 1-3 mm measured by TTE）was detected in 8 cases（8.8% ）according to the immediate TTE examination. Diameter and volume indexes of the left atrium and left ventrical decreased significantly. Removal/embolization of the device, severe valvular insufficient, infective endocarditis and thrombosis were not found during the follow-up. Conclusion： The optimum short-term and mid-term outcome of thanscatheter closure of VSD was based on prudent selection of the candidates. Echocardiography plays a very important role throughout the procedure of VSD closure, It can ensure the safety and successful rate of thanscatheter closure of VSD and reduce complications.