超声心动图在微创外科室间隔缺损封堵治疗中的应用价值

Application value of echocardiography in perventricular device closure of ventricular septal defect

目的探讨超声心动图在微创外科室间隔缺损(VSD)封堵治疗中的应用价值。方法经胸超声心动图(TTE)筛选拟行微创外科VSD封堵治疗患者169例,术中经食管超声心动图(TEE)再次评估,对具备封堵条件者进行实时引导和监控。术后3～5d及3、6、12个月TTE随访。结果术中TEE评估对15例不适宜封堵者直接改行VSD修补术。行微创封堵术154例,成功137例,成功率88.9%;封堵失败改行VSD修补术17例。术中即刻观察10例有微量残余分流,3例主动脉瓣有微量反流,7例三尖瓣反流较术前减轻或消失,11例三尖瓣出现少量反流。术后TTE随访封堵器无移位,4例残余分流消失,1例三尖瓣反流较术前略有加重,左心室重构改善。结论超声心动图在微创外科VSD封堵的术前诊断、术中监控及术后效果评价中均发挥了重要作用。

Objective To explore the application value of echocardiography in perventricular device closure of ventricular septal defect （VSD）. Methods One hundred and sixty - nine patients with VSD were selected by transthoracic echocardiography （TFE） and prepared to receive off pump surgical treatment-perventricular device closure. All the patients were re-evaluated in cardiac surgical procedures by transesophageal echocardiography （TEE）. The patients suitable to the perventricular device closure were guided and observed. After operation, 3 - 5 d, 3, 6, 12 months follow-up were performed by TTE. Results Fifteen cases were not suitable to the device closure by intraoperative TEE re-evaluation and were directly repaired under cardiopulmonary bypass. 137 of 154 cases treated with perventricular device closure were succeeded（ 137/154, 88.9% ）, 17 cases were failed and received the repair surgery. TEE was performed immediately after occluder release. The tricuspid regurgitation was decreased or disappeared in 7 patients, while the closure caused new mild tricuspid regurgitation in 11 patients, and there were 10 cases of mild residual shunt and 3 cases of mild aortic valve regurgitation. In last postoperative follow-up, no displacement was observed, and the residual shunt of 4 cases disappeared, the tricuspid regurgitation of I case was increased slightly, and left ventricular remodeling were returned to normalization. Conclusion Echocardiography plays an important role in preoperative diagnosis, intraoperative monitor and postoperative evaluation of VSD perventricular device closure.