经食管超声心动图监测微创室间隔缺损封堵术

Application of transesophageal echocardiography in minimally invasive surgical closure of ventricular septal defect

目的探讨TEE在监测探条辅助微创室间隔缺损(VSD)封堵术中的临床价值。方法 100例VSD患者术前均接受TTE检查,以明确VSD的位置、类型、大小及边缘情况,来选择合适的封堵器。在TEE引导下选择荷包开口位置,实时监测封堵器放置并即刻评价手术疗效。术后1周内行TTE复查。结果 100例患者全部封堵成功,实心探条输送法55例,中空探条输送法33例,直接输送法12例。患者均于术后3～4天出院,随访1～12个月,无封堵器脱落、移位、溶血和房室传导阻滞等并发症发生。结论 TEE在探条辅助经胸微创封堵VSD的术中引导和术后评价中均发挥重要作用,使该术成为更简便可行、成功率更高的封堵方法。

Objective To oxplore the clinical value of TEE in probe-assisted minimally invasive surgical closure of ventricular septal defect（VSD）.Methods TTE was performed in 100 patients with VSD before operation,in order to choose appropriate Amplatzer occluder according to the location,type and size of the VSD.During the operation,TEE was used to find the position of the purse and to guide the occluder device,as well as to evaluate the clinical effect immediately.Within 1 week after the closure of VSD,TTE was performed again.Results Closure of VSD was successfully performed in all patients.Solid probes were used to assist the operation in 55 patients,while hollow probes were used in 33 patients.The method of direct conveying was used to the other 12 patients.All the patients were out of hospital 3—4 days after operation.During the 1—12 months follow-up period,no complication such as Amplatzer defluvium,Amplatzer displacement,hemolysis or atrioventricular heart-block occurred.Conclusion Being simple,feasible and high-success rate,TEE plays an important role in probe-assisted minimally invasive surgical closure of VSD.