超声心动图在小腰型封堵器闭合膜部室间隔缺损中的应用

Application of echocardiography in closing perimembranous ventricular septal defect with narrow-waist occluder

目的探讨超声心动图在小腰型室间隔缺损封堵器闭合膜部室间隔缺损（perimembranous ventricular septal defect，PmVSD）中的应用价值。方法使用飞利浦Sonos-5500型彩色多普勒超声诊断仪，探头频率2～4MHz，对43例PmVSD患者术前、术中、术后进行超声心动图观测。结果①超声心动图测得室缺缺损口左室侧均大于右室侧，多数伴右室侧多孔（多束分流）。缺损口形态为不规则形或瘤形。②心血管造影测量缺损口左右室侧大小并与超声测量值比较，结果无显著性差异。③封堵器型号为4～14（7．7±2．5）mm，1例释放后出现少量残余分流，术后3d消失，余成功封堵；3例少量三尖瓣返流，近期随访观察未见明显异常。结论PmVSD缺损口形态复杂，变异较大，超声心动图指导应用小腰型封堵器闭合可获得满意的近期疗效。

AIM： To investigate the value of echocardiography in closing perimembranous ventricular septal defect （PmVSD） with narrow-waist occluder. METHODS： Forty three patients were examined by PHILIPS Sonos 5500 color Doppler imaging system with 2- 4 MHz transducer, including measuring and monitoring before, during, and immediately after closing and during follow-up. RESULTS： Size of the left side of the VSD measured by echocardiography was larger than the right side. Most right-side VSD defects were visualized as multiholes or muhishunts. VSD shapes were irregular or neoplastic. No significant difference was found between measurements of cardiovascular angiograpby and echocardiography. The size of the occluder was 4 - 14 （7.7 ＋2. 5） ram. All cases were successfully occluded except one case with trivial residual shunt, which disappeared after 3 days. Short-term follow-up was conducted in the three cases with trivial tricuspid valve regurgitations and no abnormality was observed. CONCLUSION： PmVSDs have different shapes with significant differences. Echocardiography can be used to obtain satisfactory curative effects in occluding PmVSD with narrow-waist occluder.