彩色多普勒超声心动图在先天性心脏病封堵术中的应用研究

Color Doppler ultrasonographic assessment of transcatheter closure of congenital heart disease

目的评价彩色多普勒超声心动图在先天性心脏病封堵术的应用价值。方法510例先天性心脏病,均采用Amplatzer封堵器封堵。术前、术中及术后第2天、3个月及半年复查超声心动图,观察房、室及动脉水平有无分流,各瓣膜的活动,上、下腔静脉和肺静脉、冠状静脉窦、左肺动脉及主动脉弓血流是否通畅,心脏大小及肺动脉内径的变化。结果510例成功封堵,其中279例室间隔缺损,111例房间隔缺损,120例动脉导管未闭。封堵术后观察分流已消失,封堵器均位置正常,固定良好,左肺动脉及主动脉弓降部无明显狭窄。上、下腔静脉及右肺上静脉血流通畅,对各瓣膜活动均无影响;半年后,均无残余分流,心腔内径及肺动脉内径接近正常。结论彩色多普勒超声心动图在先天性心脏病封堵术后,检测有无残余分流,左肺动脉和主动脉弓降部血流是否受阻,是否影响各瓣膜活动及腔静脉回流是否通畅,从而验证封堵器的大小选择是否合适,起到重要的作用。

Objective To report our experience in transcatheter closure of congenital heart disease using echocardiography, Methods Five hundred and ten patients underwent transcatheter closure using the Amplatzer oeeluder. Eehoeardiography was performed 2 days,3 months and half a year after operation in order to find whether there were shunts in ventricular septum,atrial septum and ductus arterious and in order to observe all valves movement and the blood flowing in superior vena eava （SVC）, inferior vena eava（IVC）, pulmonary veins （PV）, coronary sinus （CS）, aorta arch and left pulmonary arteries（LPA）, and in order to meature the size of the atrial and ventricular chambers and the pulmonary arteries. Results Successful transeatherer closure was shown in all 510 eases of congenital heart disease, among which ventricular septal defect （VSD） was 279 eases, atrial septal defect （ASD） 111 eases, patent ductus arterious（PDA） 120 eases respectively. Shunts dispeared immediately after the operation. The size and position of oeeluders suited 510 eases. Aorta arch showed no and LPA was not stenosis. The blood flowing was unblocked in SVC,IVC, PV and CS,and all valves movement was not affected. Half a year after operation, the size of the atrial and ventricular chambers and pulmonary arteries returned to normal, the residual shunts were not detected in 510 eases. Conclusion Echocardiography is of great use in choosing patients, detecting whether there are residual shunts after operation and flow of aorta and LPA, and flow return of vein and valves move after transcatheter closure of 510 eases with congenital heart,proving the size of occluders selected.