经胸超声引导下介入治疗室间隔缺损的临床研究

Transthoracic ultrasound-guided interventional therapy clinical study of ventricular septal defect

目的:探讨经胸超声(TTE)在介入治疗室间隔缺损(VSD)过程中的引导作用。方法:患者56例,男26例,女30例,年龄3～42岁,平均(15.11±8.5)岁。术前TTE严格筛选,术中跟踪观察封堵器位置、形态、有无室水平残余分流及主动脉瓣、房室瓣反流等,指导术者及时调整封堵器位置。术后准确判断封堵疗效,复查随访。结果:本组56例VSD,TTE明确诊断,准确率100%,55例封堵成功,1例因导管未能通过缺损处放弃手术,成功率98.2%。55例封堵成功的VSD超声定位准确,包括膜部27例,嵴下型25例,嵴内型3例,肌部1例。其中嵴下型VSD的缺损上缘距主动脉瓣瓣环下缘距离≥2.0mm,嵴内型VSD缺损最大径≤8.0mm,肌部VSD缺损最大径≤14.0mm。结论:TTE在介入治疗VSD中具有重要引导作用,其它任何检查方法不可替代。

Objective：To evaluate transthoracic echocardiography（TTE） in the interventional treatment of ventricular septal defect（VSD） in the lead role in the process.Methods：56 patients,26 males and 30 females,aged 3 to 42 years,mean（15.11±8.5） years.Preoperative TTE strict selection,intraoperative observation occluder tracking the location,shape,whether the level of residual shunt chamber and aortic valve,such as atrioventricular valve regurgitation surgery to guide the location of those timely adjustment occluder.Accurately determine efficacy of postoperative closure and review follow-up.Results：56 patients with VSD,TTE diagnosis,the accuracy was 100%,55 cases of closure,but 1 case of catheter through the defect can not give up the operation,the success rate of 98.2%.55 cases of successful VSD closure ultrasonic positioning accuracy,including membranous in 27 cases,25 cases of type under the ridge,crest in 3 cases,1 case of muscular.Under the crest of which type of defect VSD prosthetic aortic rings from the upper edge of the lower edge of distance ≥ 2.0 mm,ridge-type VSD defect in maximal diameter ≤ 8.0 mm,muscular VSD defect in maximum diameter ≤ 14.0 mm.Conclusion：TTE in the interventional treatment of VSD in an important guiding role of any other inspection methods can not be replaced.