超声心动图在微创外科房间隔缺损封堵治疗中的应用

Application of echocardiography on minimally invasive surgical closure of atrial septal defect

目的探讨超声心动图在微创外科房间隔缺损（ASD）封堵治疗中的应用价值。方法术前经胸超声心动图（TTE）筛选单纯继发孔中央型ASD95例，术中经食管超声心动图（TEE）进一步评估引导微创外科封堵治疗，术后3～6月TTE随访。结果95倒患者行ASD微创外科封堵术，封堵成功86例，占90．5％，9例封堵失败。TEE与TTE对ASD最大径及残缘测量值差异无统计学意义（P〉O．05）。房间隔伸展径TTE测量值大于TEE（P〈0．01）。TTE对上、下腔静脉缘的显示率为71．6％和77．8％，低于TEE（P〈0．01）。术后3～6个月1vrE随访，封堵器位置稳定，无移位，未影响周围瓣膜功能及静脉回流，1例有微量残余分流。右心重构改善，右房、右室内径较术前缩小，肺动脉血流速度降低（P〈0．01）。结论超声心动图贯穿了微创外科ASD封堵治疗的全程，TEE与TTE联合应用，对术前诊断与筛选、术中选择封堵器和实时监控、术后效果评价发挥了重要作用。

Objective To evaluate the clinical value of echocardiography in minimally invasive surgical closure of atrial septal defects （ASD）. Methods Ninety-five patients with isolated secundum central ASD were included based on preoperative TTE results, and received minimally invasive surgical closure under simultaneous assessment and guidance of intraoperative TEE. All patients were followed up for 3 to 6 months using TTE. Results TEE guided minimally invasive surgical closure was successful in 86 patients （90.5%）, and failed in 9 patients who later received surgical repair. The maximum diameter and residual margins of ASD measured by TEE and TTE were no significantly different （P〉0.05）. However, maximum diameter of atrial septum measured by TTE was significantly greater than that by TEE（P〈0.01）. The rate of satisfying display ofASD margins near superior vena cava and inferior vena cava by TTE was 71.6%and 77. 8%, respectively, which were significantly lower than that of TEE （P〈0. 01）. During 3 to 6 months follow-up, oecluder was well fixed and didn＇t affect the function of atrial-ventricular valves and venous return. Only 1 patient was found with trace residual shunt. The remodeling of right atrium and right ventricle was reversed with decreased dimension, and the pulmonary artery flow velocity was significantly reduced after surgery （P〈0. 01）. Conclusion In our study, echocardiography was performed throughout the course of minimally invasive surgical closure of ASD. Combined application of TEE and TTE was effective in providing preoperative diagnosis and screening for eligible patients, intraoperative guidance for the selection of appropriate occluder and real-time monitoring, as well as evaluation during postoperative followup.