经胸微创室间隔缺损封堵术临床分析

Clinical analysis of transthoracic minimally invasive ventricular septal defect occlusion

目的探讨在食管超声心动图（TEE）引导下应用国产封堵器经胸微创封堵室间隔缺损的临床价值。方法2011年5-8月20例室间隔缺损患儿术前行胸超声心动图检查，符合封堵条件者在全身麻醉下经口插入食管超声探头，根据室间隔缺损最大直径选择合适的封堵伞。手术开始后TEE监测整个封堵过程，引导封堵伞的位置，评价即刻封堵效果，确认是否有残余分流及并发症。结果20例患儿全部封堵成功，TEE显示封堵器与室问隔缺损边缘吻合紧密无残余分流，术后4-7d复查彩色多普勒超声显示无分流及并发症，疗效满意。结论TEE经胸微创治疗室间隔缺损封堵术，安全有效，无需体外循环，创伤小，无x线辅助，住院时间短。

Objective To investigate the value of transesophageal echocardiography guided occluded opera- tion for ventricular septal defects （ VSD ） through the lower ministernotomy. Methods Total 20 patients with per- imembranous VSD were in the study. VSD patients （20 cases ） were given preoperative transthoraeie echocardio- graphy. Under general anesthesia, the patients who were meeting the blocking condition had the transesophageal echocardiograph. The size of occluder was decided according to the diameters of VSD. During operation, ultrasound was applied to monitor the procedure of occlusion and to evaluate if there were peripheral residual shunts around the occlusion and other complications. Results The occluded operations of 20 VSD patients were performed successfully. Conclusions Transesophageal eehocardiography, as a safe and simple method, plays an important role in selecting patients and determining the size of the occluder correctly before occlusion operation. It guides the placement of the occluder in operation and evaluates the effect of operation.