经胸与经食管超声心动图在室间隔缺损外科封堵中的应用价值

APPLICATION VALUE OF TTE AND TEE IN DEVICE CLOSURCE OF VENTRICULAR SEPTAL DEFECTS

目的:评价经胸与经食管超声心动图在室间隔缺损外科封堵中的价值。方法:2009-08～2011-06经我院心外科确诊的室间隔缺损病人29例。膜周型缺损21例,嵴内型缺损8例。缺损直径3～9mm,平均5.35±3.12mm。术前用经胸超声心动图观察缺损大小及缺损与主动脉瓣的距离。在经食管超声的引导下,经右室游离壁置入国产室缺封堵器。术后用经食管超声即刻评价封堵效果,出院前及封堵3mo后用经胸超声心动图随访观察。结果:25例封堵成功,使用等边封堵器18例,7例偏心封堵器,术后即刻超声及术后超声观察均无分流信号,2例病人术后出现少量三尖瓣反流。2例膜周型缺损TEE发现缺损处有多处破口无法进行封堵。2例嵴内型封堵失败,即刻术中行开胸修补术。结论:经胸与经食管超声心动图在室间隔缺损外科封堵术前评估、术中监测及术后随访中发挥重要的价值。

objective ： To access the application value of TTE and TEE in device closurce of ventfic- ular septal defects. Methods： From August 2009 to June 2011, A total of 29 patients diagnosised with VSD （17 males and 12 females）underwent TIE preoperative assessment in the cardial surgical depart- ment in our hospital. 21 cases with Perimembranous VSD, other 8 cases with intracristal type VSD. The defect diameter ranges from 3mm to 9ram, the average value is 5.35 _＋ 3.12mm. Used TIE to access defect size and distance from the aortic valve in preoperative. Introduce domestic ventricular septal de- fect occluder through right ventricular free wall under the guidance of TEE. Immediate evaluate postop- erative effect with TEE,TIE was used to follow - up study in the prior to dischargr and three months after. Results：The procedures were successful in 25 cases. Equilateral occluders were used in 18 ca- ses, eccentric occluders in 7 cases. There was no signal of shunt observed by immediate postoperative TEE in the 25 cases,2 patients had mild tricuspid regurgitation after operations. Two cases of perimem- branous type of defect with multiple crevasse can not be occludered. Two cases within the intracristal type defect occluder failure, immediate intraoperative thoracotomy neoplasty. Conclusions： rl^E and TEE has an important value in the preoperative acessment, intraoperative monitoring and postoperative evaluation in minimally invasive perventrieular.