经食管超声心动图在偏心型封堵器治疗室间隔缺损微创镶嵌术中的应用

Transesophageal Echocardiography Guidance for a Hybrid Patch Closure of Ventricular Septal Defect Using Domestic Eccentric Shape Ventricular Septal Defect Occluder

目的研究经食管超声心动图(TEE)指导、监测偏心型封堵器在经胸微创行室间隔缺损镶嵌术中的临床价值。资料与方法回顾性分析利用偏心型封堵器成功治疗的16例室间隔缺损的镶嵌术,术前TEE详细观察缺损部位、大小及周边的解剖关系,供术者选择合适封堵器,指导、监测整个封堵过程,评价即刻封堵效果。结果 TEE测得术前室间隔缺损直径3～6mm,平均(4.56±0.75)mm,使用的偏心型封堵器直径5～8mm,平均(6.06±0.71)mm。TEE显示封堵器与室间隔缺损边缘吻合紧密,主动脉瓣反流无加重,2例封堵器边缘存在细小左向右分流(分流束<1.5mm)。随访1、3、6个月,封堵器位置正常,无残余分流,未出现主动脉瓣反流。左心房、室径线较术前明显减小,基本恢复正常水平。结论在TEE指导和监测下,应用偏心型封堵器治疗主动脉瓣下室间隔缺损的微创镶嵌术创伤小,安全性高,近期疗效满意。

Purpose To evaluate the clinical value of transesophageal echocardiography（TEE） in minimal invasive transthoracic closure of ventricular septal defect（VSD） using eccentric type occluders for hybrid procedure.Materials and Methods 16 cases who had successfully undergone hybrid closure of VSD were analyzed retrospectively.The defect location,size,and the surrounding anatomy of VSD were carefully observed before operation,to help the operators to choose the appropriate occluder,guide and monitor the entire surgical process,and to evaluate the immediate closure effect.Results The diameter of the VSD ranged from 3 to 6 mm before operation,averaging（4.56±0.75） mm.The diameter of all eccentric type occluders ranged from 5 to 8 mm,averaging（6.06±0.71） mm.16 cases were all performed successfully without worsening aortic valve regurgitation.The occluders were coincided closely with the defect edges showing by TEE.Two cases had tiny residual left-to-right shunt（ 〈1.5 mm）.The patients＇ occluders were all in normal position on follow-up examination at 1 month,3 months and 6 months after operation.There was no residual shunt and aortic valve regurgitation,the diameters of left atrial and ventricular diameter were significantly reduced than preoperation,and tended to be normal.Conclusion The hybrid surgery of the VSD located abutting on the aortic valve using eccentric type occluder guiding and monitoring by TEE is a safe method with good short term effect.