胸腔镜及胸腔小切口开窗置入新型房间隔缺损闭合器及其超声检测意义

Closure of atrial septal defect with occluder by thoracoscopic and chest small incision ways and detective value of echocardiography

目的 探讨胸腔镜及经胸小切口开窗新术式置入新型房间隔缺损闭合器的方法和超声监测意义。方法 18例房间隔缺损患者 ,全麻下用胸腔镜或直接右胸壁小切口开窗 ,经右房置入DASDO圆形或椭圆形闭合器。经食管超声心动图术中观测各切面观缺损大小及周缘情况 ,选择闭合器类型及大小。超声监测下于缺损两侧释放闭合器双伞 ,确认牢固及无明显房水平分流后释放闭合器。结果 17例房间隔缺损患者封堵成功 ,1例失败。房间隔缺损最大径为 8～ 32mm[平均 ( 19.3± 6 .3)mm ]。缺损各方向边缘最短者距主动脉后壁无缘 ,距上腔静脉 3 .5mm ,距下腔静脉 6 .0mm ,距二尖瓣根部 6 .0mm。超声引导下封闭房间隔缺损用时约 2～ 3min。结论 经胸小切口开窗置入闭合器是一种介入性房间隔缺损治疗的新术式 。

Objective To explore the method of atrial septal defect (ASD) occlusion with occluder by thoracoscopic and chest small incision ways and detective value of echocardiography.Methods Eighteen patients with ASD were anaesthetized,and a DASDO round or elliptic occluder was placed in heart by thoracoscopic or chest small incision ways.The ASD size and edge in various sections were measured by transesophageal echocardiography,and the type and size of occluder were accordingly selected.Two umbrellas were opened on two sides of ASD under monitor of echocardiography.After confirming the firm of occluder and no evident atrial shunt,occluder was released,and right atrium and chest were sewed.Results Seventeen patients with ASD were successfully occluded and one case was failed.The maximum diameter of ASD was 8～32 mm[mean ( 19.3 ± 6.3 )mm].The shortest edges in variant sides were 0 mm to posterior wall of aorta, 3.5 mm to superior vena cava, 6.0 mm to inferior vena cava and 6.0 mm to the base of mitral valve.The time to close ASD guided by echocardiography was about 2～3 minutes.Conclusions To place ASD occluder through small incision of chest is a new method for interventional treatment of ASD,which might have wider indication for ASD occlusion.