双平面经食管超声心动图在Amplatzer堵塞器经心导管关闭小儿房间隔缺损中的价值

Role of transesophageal echocardiography in transcatheter closure of atrial septal defect with Amplatzer occlusion device

目的 评价经食管超声心动图 (TEE)在Amplatzer堵塞器经心导管关闭房间隔缺损 (ASD)中的应用价值。方法 对 5 7例继发孔型ASD患者 ,在TEE监测下应用Amplatzer堵塞器经心导管关闭ASD。结果48例获得成功 ,由于术前经胸超声心动图诊断不准确 ,9例未成功。ASD的经胸超声测量值与球囊伸展径间差异有显著性意义 (P <0 .0 1) ,但相关 (r =0 .87,P <0 .0 1) ;TEE测值与球囊伸展径间高度相关 (r =0 .93,P<0 .0 1)。术后即刻TEE检查显示 7例患者存在微量残余分流。结论 TEE可以准确地显示ASD的大小、部位及其边缘的解剖形态 ,有利于术前病例的选择、术中闭合器的安置及术后即刻疗效的判定 ,是一种安全。

Objective To evaluate transesophageal echocardiographic guidance for transcatheter closure of atrial septal defect (ASD) with the Amplatzer occlusion device.Methods Transcatheter closure of ASD was performed using the Amplatzer occlusion device under the guidance of transesophageal echocardiography(TEE) in 57 patients with secundum ASD.Results Forty eight of 57 patients had succsesful implantation of Amplatzer occlusion device.The remaining 9 patients were unsuccessful due to inaccurate measurements of the size,location and morphology of ASD by transthoracic echocardiography.There were significant differences between the size of ASD measured by transthoracic echocardiography and ballon-stretched diamension (P< 0.01),although there was a correlation (r= 0.87,P< 0.01).There was no significant differance between TEE and ballon-stretched diamension (P> 0.05),correlation was better than those measured by transthoracic echocardiography (r= 0.93,P< 0.01).Trivial residual shunt was found in 7 patients.Conclusions TEE could clearly demonstrate the location,size and morphology of ASD.It was valuable for selection of patients before the procedure,deployment of the Amplatzer occlusion device during procedure and evaluating the therapeutic effects.It was a safe and effective guidance technique.