经食管超声心动图在经胸微创封堵室间隔缺损术中的应用

Value of transesophageal echocardiography in case selection of transthoracic minimally invasive device closure of ventricular septal defect

目的评价经食管超声心动图(TEE)在经胸微创封堵室间隔缺损病例选择和治疗中的应用价值。方法 2007年1月至2010年10月我中心对164例单纯室间隔缺损患者进行经胸微创封堵手术,其中膜周室间隔缺损138例,肌部室间隔缺损3例,流出道部室间隔缺损23例。采用四腔观、大动脉短轴观、左心室长轴观、五腔观、右心室流入道观等评估患者采用微创封堵的可能性。结果164例患者中152例(92.7%)植入封堵器成功封堵。全部病例随访3个月以上,无Ⅲ度房室传导阻滞和瓣膜并发症。5例存在少量左向右反流者3例自愈。结论 TEE在经胸微创封堵室间隔缺损病例选择术中具有重要价值,选择好适宜手术的病例是手术成功的关键。

Objective To evaluate the value of transesophageal echocardiography （TEE） in transthoracic minimally invasive device closure of ventricular septal defect（VSD）.Methods A total of 164 cases of VSD were recruited as candidates to receive transthoracic minimally invasive device closure between January 2007 and October 2010,including 138 perimembranous VSDs,3 muscular VSDs and 23 supracristal VSDs.Among these groups,85 male patients were included.Four-champer view,five-champer view,left ventricular long-axis view,short-axis view and right ventricular inflow view were detected to evaluate the availability of device closure.Results A total of 152 cases（92.7%）were successfully closed with a device.All the patients were followed up more than 3 months arranged with a standard protocol.No complete atrioventricular block （CAVB） or associated valvular complications were observed.Three of the five cases with traced residual shunt after device closure closed spontaneously.Conclusion TEE plays an important role in transthoracic minimally invasive device closure of ventricular septal defect,which has been proved by the good follow-up results without CAVB and associated valvular complications.