经食管超声心动图引导微创封堵缺乏边缘的房间隔缺损的应用价值

Value of intraoperative closure atrial sepetal defect with deficient rims inducted by transoesophageal echocardiography

目的评价经食管超声心动图（TEE）在微创术中引导封堵缺乏边缘的房间隔缺损的应用价值。方法经胸超声心动图检查诊断为房间隔缺损患者23例，拟行微创非体外循环下封堵治疗。术前行TEE检查，明确房间隔缺损的位置、类型、大小及边缘情况，用以确定选择合适的封堵器，术中TEE引导封堵器放置，评价即刻效果，术后1周内复查经胸超声心动图检查。结果23例患者封堵成功，TEE显示20例无残余分流，3例少量残余分流；但术后1周经胸超声心动图随访，均见封堵器位置正常，无残余分流，且右房右室较术前缩小（P〈0．05），肺动脉压力下降（P〈0．05）。结论TEE在微创术中引导缺乏边缘的房间隔缺损封堵中起着主导作用。

Objective To evaluate the application valve of intraoperative device closure secundum atrial sepetal defect （ASD） associated with deficient rims inducted by transoesophageal echocardiography （TEE）. Methods Twenty three patients with ASD were diagnosed by transthoracic eehocardiography （TTE） ,and underwent an attempted intraoperative device closure through a right antierior minithoractomy. The positon,type and size and rim of ASD were defined by TEE in preoperation,the placement of the device inducted and evaluated by TEE intraoperation,and followed by TTE after one week. Results Twenty-three patients with ASD were closed excellently. There were not shunt of atrial level in 20 patients, trivial shunt in 3 patients. However,follow up after one week TTE indicated that all patients had no shunt,and the diameter of right atrium and right ventricle was decrease significantly （ P ~ 0.05）, and pulmonary artery pressure was less than before （ P d0.05）. Conclusions It is very important that TEE induct the closure of ASD associated with deficient rims in micro-operative room.