术前超声分型在膜部瘤型室间隔缺损介入治疗中的应用

The clinical value of ultrasonography in aneurysm of membranous ventricular septal defect typing before interventional therapy

目的探讨经胸彩色超声心动图在膜部瘤型室间隔缺损(VSD)介入治疗术前超声分型的临床应用价值。方法40例患者行经导管膜部瘤型VSD封堵术,经胸彩色超声心动图行术前筛选分型、术中监测及术后复查。术前超声检查将膜部瘤型VSD的解剖特点分为4种类型:1型为囊袋型,2型为漏斗型,3型为菜花型,4型为管状型。结果40例膜部瘤VSD中,囊袋型20例、漏斗型10例、菜花型4例及管状型6例,全部成功封堵,术中造影证实术前超声测量膜部瘤VSD部位、形态、大小(包括右室面缺损外口大小数目、左室面缺损内口、膜部瘤深度、宽度)与实际一致,封堵成功,5d后经胸超声检查未见残余分流。结论经胸彩色超声心动图在膜部瘤VSD分型封堵术前有着重要的应用价值。

Objective To investigate the clinical application value of transtoracic echocardiography in typing of the aneurysm membranous ventricular septal defect（VSD） before intervenfional occlusion. Methods Forty patients suffered from aneurysm of the membrranous VSD underwent transcatheter occlusion with domestic occluder, which was made by nickel- titanium alloy with doubleleg sitting tailor- fashion architecture. Preoperative screening and typing, monitoring during operation, and postoperative re- examination were executed with transthoracic echocardiography. According to the anatomic feature, the aneurysm of membranous VSD was classifted into 4 types by echocardiography before operation： sac type, funnel type, fungating type and ductus type. Results 40 cases were classified into 4 groups： 20 sacs, I0 funnels, 4 fungatings and 6 ductuses, and all VSDs were occluded successfully. The visualization during operation verified that it was conformed with the preoperative ultrasonometry in the location, morphous and size（ including the size of debouch on left surface of the septum, depth and width of the sack, the number and size of debouch on fight surface of the septum） . The re - examination was carried out 5 days after operation and there was no residual shunt. Conclusion Transthoracic echocardiography possess important clinic value in aneurysm of the membranous ventricular septal defect typing before interventional occlusion.