食管超声引导下经胸微创封堵先天性心脏病的临床应用分析

Clinical application analysis of transesophageal echocardiography guidance minimally invasive transthoracic closure for treating congenital heart disease

目的总结食管超声引导下非体外循环经胸微创封堵先天性心脏病的临床应用经验。方法选择2011年11月~2013年5月食管超声引导下经胸微创封堵房间隔缺损（ASD）、室间隔缺损（VSD）患者65例,其中ASD 18例,VSD 47例。对术前、术中及术后情况进行回顾性分析。结果无手术死亡。中转体外5例。封堵成功患儿均于术后4 h内撤离呼吸机,监护室滞留1 d,术后3~5 d出院。复查心脏超声仅1例膜周VSD有轻微残余分流,随诊观察6个月后自行闭合。余患儿均无残余分流。1例术后心包积液,行心包穿刺后痊愈。1例患儿术中发生Ⅲ度房室传导阻滞,术后3 d恢复。全部病例均无溶血发生。结论食管超声引导下经胸微创封堵治疗先天性心脏病无需体外循环及输血,操作简单,安全可靠,值得推广。食管超声对缺损结构的准确反映和正确引导是手术成功的关键。

Objective To summarize the clinical experience of minimally invasive transthoracic closure for treating congenital heart disease without cardiopulmonary bypass under transesophageal echocardiography.nethods A total of 65 cases of patients with atrial septal defect （ASD） and ventricular septal defect （VSD） were selected to receive transthoracic minimally invasive device closure guidanced transesophageal echocardiography in our hospital from November 2011 to May 2013,including eighteen cases of ASD and forty-seven cases of VSD.The conditions of preoper- ative,intraoperative and postoperative patients were reviewed.Results There was no death.Five patients were changed to cardiopulmonary bypass during the operation.Among the successful transthoraeic closure of the patients,all of them were weaned from the ventilator in four hours postoperative,stayed in ICU for one day,and discharged 3 to 5 days after oper- ation.One patient with perimembranous VSD by reviewing echocardiography had a tiny residual shunt,and then closed spontaneously after the following up six months later, others had no residual shunt.One patient after operation had peri- cardial effusion,and then recoverd through pericardium puncture.One patient occurred III degree atrioventricular block, and then recoverd in 3 days after operation.All cases had no hemolysis.Conclusion Transesophageal echocardiography guidance minimally invasive transthoracic closure for treating congenital heart disease without cardiopulmonary bypass or blood transfusion is simple,safe,reliable and the technology is worth popularizing widely.Transesophageal echocardio- graphy who can accurately reflect the defect structure and correct guidance is the key to successful operation.