经胸超声心动图在继发孔房间隔缺损封堵术围手术期中的应用价值

The application value of transthoracic echocardiography in perioperative period of transcatheter closure of ostium secundum atrial septal defects

目的评价经胸超声心动图(TTE)在继发孔房间隔缺损(ASD)围手术期中的应用价值。方法术前筛选86例有外科手术适应证的继发孔ASD患者,TTE测量各切面ASD大小及残边情况,指导选择封堵器(ASO)型号,术中监测ASO置放及释放过程,术后随访观察。结果 86例患者术前TTE测得ASD最大直径5～34(24.4±5.63)mm,所用ASO直径为8～40(27.5±7.12)mm。TTE成功引导81例ASO置入,总成功率为94.2%,其中双孔ASD2例,均置入单个ASO成功。5例术后即刻有微量或少量残余分流,术后3个月复查TTE分流完全消失。结论经导管ASD封堵术是安全可行的方法,TTE对ASD封堵术前病例选择、残边评估、ASO型号选择、术中监测ASO的置放全过程和术后疗效评价有重要临床价值。

Objective To evaluate the applied value of transthoracic echocardiography（TTE） in periopera- tive period of transcatheter closure of ostium secundum atrial septal defects （ASD）. Methods Eighty six patients with ostium secundum ASD waiting for surgical treatment underwent TIE for pre-operative assessment of ASD size and rims on various views, selection of amplatzer septal occluder（ ASO）, monitoring setting and releasing of occluder in operation and post-operation follow-up. Results The size of ASD measured by TTE was 5 -34 （24.4 ± 5. 63）mm in 86 patients before operation, the size of selected occluder was 8 - 40 （27.5 ± 7. 12）ram. Eighty-one cases were suc- cessfully treated with ASO （94. 2% ）, including 2 cases with multiple ASD. Five patients with residual shunt were found immediately after the operation. During the 3 months follow-up, all residual shunts disappeared. Conclusion Transcatheter closure is a safe and effective method in patients with ostium secundmn ASD. TTE have important clini- cal value in choice of ASD patients and the size of occluder device, monitoring setting and releasing of occluder in op- eration and evaluation of the treatment efficiency.