经胸超声心动图三维空间构像法测量房间隔缺损的评价

Evaluation of atrial septal defect by three-dimension composing image of transthoracic echocardiography

目的评价经胸超声心动图三维空间构像测量房间隔缺损的方法在封堵术中决策选用Amplatzer封堵器的应用价值。方法术前通过多切面(心尖四腔、大血管短轴及剑下四腔)测量房间隔缺损多个方位的直径及残端(硬缘和软缘)情况,形成房间隔缺损的经胸三维空间构像,据此决定选用Amplatzer封堵器的型号。术中封堵器置入房间隔缺损后,采用三维空间构像法实时观察封堵器位置、稳定性及是否存在残余分流。结果96例患者根据术前经胸三维空间构像法测量房间隔缺损直径和残端情况而选用相应型号的封堵器,一次性成功置入93例(96.7%),术中实时监测显示房间隔封堵器置入位置正常,推拉试验显示封堵器固定良好,左向右分流信号完全消失。3例患者(3.1%)因房间隔解剖变异或残端偏差而出现微量残余分流,及时更换封堵器后残余分流信号完全消失。结论经胸超声心动图三维空间构像法测量房间隔缺损简捷准确,为决策Amplatzer封堵器型号的选用提供了一种可靠的方法。

Objective To evaluate the clinical value of three - dimension composing image of transthoraeie echocardiography in selecting the type of Amplatzer occludcr device for atrial septal defect （ ASD ）. Methods The ASD diameter and its stump（ hard rim and soft rim）were measured from multitude position to form a three dimension composing image via apical four chamber view, great vessels short axis view and subxiphoid four chamber view before operation. The type of Amplatzer occluder device were selected as above for transeatheter occlusion of ASD. After Amplatzer oecluder device was inserted between the ASD stumps,its position,stability and whether a residual shunt occurred were observed by three dimension composing image in real time. Results 96 cases of ASD adopted corresponding occluder according to the results of three - dimension composing image,and Amplatzer occluder device occluded ASD of 93 cases successfully at the first time（96.7% ）. The real time monitor during operation showed that Amplatzer occluder deviceg position and its stability were good, and no residual shunt was found. Due to anat - variant of ASD or its stumps deviation, there was microdosis residual shunt in 3 eases （3.1% ） , and after the Amplatzer occluder device was replaced in time, the microdosis residual shunt disappeared wholly at once. Conclusion Measuring ASD by three - dimension composing image of transthoraeic echocardiography is convenient and accurate, and it is a reliable method for selecting the type of Amplatzer occluder device in ASD patients.