经胸超声心动图在动脉导管未闭封堵术中的应用价值

The application of transthoracic echocardiography in performing transcatheter occlusion of patent ductus arteriosus

目的评价经胸超声心动图(TTE)指导动脉导管未闭(patent ductus arteriosus,PDA)封堵术术前及术中的应用价值。方法 2008年5月至2012年5月收治132例PDA患者,术前用彩色多普勒超声诊断仪经胸观察PDA形态,并测量各切面PDA内径,据此结果直接选择相应封堵器。经心导管PDA封堵术中应用TTE监测介入过程,确定封堵器牢固程度及有无残余分流。结果 TTE术前检查PDA直径为2～12 mm,平均(5.49±1.93)mm,选用PDA封堵器大小为4～22 mm,平均(10.43±2.91)mm。超声测量PDA直径与封堵器大小相关性良好(r=0.74,P<0.001)。手术成功率100%,封堵器牢固,无脱落,无分流。结论 TTE术前及术中直接指导PDA封堵术是一种可行、有效、便捷的方法,尤其适用于小儿。

Objective To discuss the application value of transthoracic echocardiography （TFE） in guiding the performance of transcatheter occlusion of patent ductus arteriosus （PDA）. Methods During the period from May 2008 to May 2012, a total of one hundred and thirty-two patients with PDA were admitted to authors＇ hospital. The patient＇s age ranged from 7 months to 67 years. Before operation the size and shape of PDA were measured by TTE （GE vivid7 and Philips IE33）. The inner diameter of the relevant cross-sections were determined, based on which the proper occluder was selected for each patient. With the help of TTE monitoring the transcatheter occlusion of PDA was carried out. The fixation degree of the occluder was estimated, and the presence or absence of residual shunt was determined. Results Preoperative TI＇E examination showed that the diameter of PDA was 2 - 12 mm with a mean of （5.49 ±1.93）mm. The size of occluder used in the operation was 4 - 22 mm with a mean of （10.43 ± 2.91 ）mm. A significant correlation existed between the PDA diameter measured by TIE and the size of the used occluder （r = 0.74, P 〈 0.001）. The success rate of the operation was 100%. All the occluders were fixed tightly and none of them fell off. No residual shunt was observed. Conclusion Preoperative TIE examination is very helpful in selecting proper occluder, and TIE is also very helpful in guiding the performance of transcatheter occlusion of patent ductus arteriosus. TIE is clinically feasible, effective and simple, and this technique is especially useful in child.