先天性心脏病封堵器治疗随访过程中彩色多普勒超声的应用

Color Doppler ultrasound in the follow-up of occluder-treated congenital heart disease

背景：目前先天性心脏病（先心病）房间隔缺损、室间隔缺损、动脉导管未闭的封堵器治疗替代了传统的外科手术,彩色多普勒超声（彩超）在封堵治疗随访中得到广泛应用。目的：评价彩超在先心病封堵器治疗随访过程中的应用价值。方法：由第一作者采用电子检索的方式,在万方数据库（http：//www.wanfangdata.com.cn/）中检索1999-01/2009-12有关先心病封堵器随访过程中彩超作用的文章,关键词为＂彩超,先心病,房间隔缺损,室间隔缺损,动脉导管未闭,封堵器＂。经检索共查到相关文献50余篇。经阅读标题、摘要、全文后,排除内容重复、普通综述、Meta分析类文章后筛选纳入24篇文献进行评价。结果与结论：封堵器选择根据超声心动图和左心室造影测量的缺损大小、距主动脉右冠瓣的距离,选择合适的类型和大小,选择较符合适应证的病例是封堵成功的关键。由记忆镍钛超弹性合金编织而成的Amplatzer先心病封堵器置入人体后,具有良好的生物相容性及安全性,封堵后3~5年内用彩超进行跟踪随访,患者未出现明显不良反应,封堵器位置固定,无移位。于封堵前行彩超检查确定先心病封堵的适应证;封堵过程中指导临床医生选择封堵器的大小,观察封堵器的位置,以及缺损部位有无残余分流;封堵后随访治疗效果。在先心病封堵器治疗过程中,彩超在封堵前检查、封堵过程中监测以及封堵后随访中均具有重要的应用价值。

BACRGROUND： Currently, occluders, instead of traditional surgeries, are used for treatment of atrial septal defect, ventricular septal defect, patent ductus arteriosus due to congenital heart disease. As a result, color Doppler ultrasound is widely used in the follow-up of occlusion therapy. OBJECTIVE： To assess the value of color Doppler ultrasound in the follow-up of occluder-treated congenital heart disease. METHODS： The first author performed an electronic retrieve of Wanfang database for articles related to the follow-up of occluder-treated congenital heart disease published from January 1999 to December 2009. The keyword were ＂color ultrasound, congenital heart disease, atrial septal defect, ventricular septal defect, patent ductus arteriosus, occluder＂. Repetitive articles, reviews and Meta analysis were excluded, and finally 24 articles were included in the result analysis. RESULTS AND CONCLUSION： The appropriate occluder was chosen according to defect size and distance between the defect and the right coronary aortic valve measured based on echocardiography and left ventricular angiography. Selection of cases with appropriate indications by using color Doppler ultrasound was the key to successful occlusion. The Amplatzer occluder made of superelastic nickel-titanium memory alloy had a good biocompatibility and safety. During the follow-up of 3-5 years, patients receiving the implantation of the Amplatzer occluder showed no adverse effects, and the occluder position was fixed and did not shift. During the treatment of congenital heart disease with occluders, color Doppler ultrasound plays an important role in preoperative examination, intraoperative monitoring and postoperative follow-up.