超声指导房间隔缺损并发肺动脉高压的封堵治疗

Guidance of Atrial Septal Defect Associated with Pulmonary Hypertension Occlusion by Using Transthoracic Echocardiography

目的评价经胸超声心动图（TTE）术前测量房间隔缺损（ASD）大小，估测肺动脉高压（PH）及术中监测ASD封堵的作用。方法5例ASD并发PH患者术前用彩色多普勒超声诊断仪经胸测量各切面ASD大小和周缘情况，并根据三尖瓣反流压差估测肺动脉收缩压，经心导管ASD封堵术中TTE监测封堵过程、伞释出后牢固程度及彩色多普勒有无分流．ASD并发PH重度患者试封堵30分钟，超声监测效果。结果用TTE术前检查ASD大小25～34（28．2±3．78）mm．选用的封堵器大小为30～38（34.0±3．29）mm。硬缘ASD的封堵器选择比超声所测ASD大4～6mm。所有封堵器封堵牢固．无脱落。结论TTE术前检查及术中指导ASD并发PH患者封堵是一种可行、有效、简便的方法。

Objective To evaluate the value of transthoracic echocardiography（TTE） on measurement of atria septal defect（ASD） associated with pulmonary hypertension（PH） before occlusion and monitoring ASD occlusion during operation, Methods Five patients with ASD associated with PH, were occluded by using transcatheter occluder. The ASD size and edges invarious sections were measured by use of Color Doppler systems. The peak systolic pulmonary pressure were obtained by echocardiography Doppler according to the tricuspid regurgitation gradient pressure. Operation of occlusion, firmness of umbrellas and residual shunt were monitored and detected by TTE. Results Size of ASD measured by TTE were25-34（28.2±3.78）mm before operation. Selected occluder were 30-38（34, 0±3.29）mm. The occluder size was4-6 mm larger than ASD size in solid edge ASD. All of occluder fixed tightly and none of them fell of. Conclusions ASD associated with PH occlusion guided by TTE before and during operation is a feasible,effective and simple method.