经胸超声心动图监测介入封堵治疗缺损性先天性心脏病

Applied value of transthoracic echocardiography during peri -occlusion of defective congenital heart disease

目的评价经胸超声心动图在缺损性先天性心脏病(先心病)封堵术中的应用价值及观察封堵术后的近期疗效。方法本组选择各种缺损性先心病患者30例,男11例,女19例。其中房间隔缺损6 例,室间隔缺损16例,动脉导管未闭6例,左室右房通道1例,室间隔膜部瘤破裂1例。超声心动图封堵术前观察各种缺损类型、大小、形态,术中封堵器的释放监测,术后观察封堵术疗效。结果房间隔缺损 8．0-18．0mm,平均约12．8mm;室间隔缺损2．5-8．0mm,平均约4．6mm;动脉导管未闭3．0-7．0mm,平均约 3．5mm;室间隔膜部瘤破裂口约2．7mm,室间隔缺损口距主动脉的距离>2．0mm;各种缺损选择的封堵器号, 房间隔缺损6．0-30．0mm;室间隔缺损4．0-12．0mm;动脉导管未闭4．0mm;三者平均11．2mm。室间隔缺损口距瓣膜距离过小者应用偏心型封堵器。30例封堵术成功率达100％。其中2例封堵后出现少量返流,均为室缺。1个月后1例呈微量残余分流,1例残存分流消失。术中出现相应心律失常,多以早博及传导阻滞出现,术后逐渐消失。结论经胸超声心动图可准确观测各种缺损性先心病的缺损大小、形态及与周边的结构关系,用以指导封堵器大小的选择和释放观测,评价封堵术后疗效。

Objective To evalute the applied value of transthoracic echocardiography during periocclusion of defective congenital heart disease and to observe the short-term therapeutic effect of occlusion.Methods Thirty patients with defective congenital heart disease were subjected to occlusion, including llmales and 19 females. This group included 6 cases of ASD （atrial septal defect）, 16 cases of VSD （ventricular septal defect）,6 cases of PDA （patent ductus arteriosus）, one case of left ventricle - right atrium connection and one case of ventricular septal tumor rupture.The type,size and shape of defections were detected before operation echocardiographically,occlusions of defections were monitored during operation and therapeutic effect were observed after operation.Results Sizes of ASD were 8.0-18.0mm （mean about 12.Smm）; Sizes of VSD were 2,5-8.0mm （mean about 4.6ram）; Sizes of PDA were 3.0-7.0mm （mean about 3.5mm）; Size of the ventricular septal tumor rupture gap was 2.7mm, The distance from VSD or ASD to aortic valve was more than 2mm; Different sizes of occluders for varies defects, 6.0-30.0mm for ASD; 4.0-12.0mm for VSD;4.0mm for PDA （mean 11.2mm of the three）. Asymmetric duct occluder should be used in VSA which valve was close to the pert. All of the 30 patients were subjected to occulusion procedure successfully,in which two patients of VSA had small reflex after occlusion, then later 1 month one patient＇s residual shunts were disappeared and another only left micro-volume. The corresponding conduction blockades （mainly,premature pulse and conduction blockade） during the operation were disappeared gradually.Conclusion Echocardiography can measure the size and shape of defects in defective congenital heart disease and their relationships to adjacent structures so that accurately to guide the size choice of occluders and survey the release of the occluder, and to evaluate the therapeutic effects of occlusions.