经食管超声心动图对房间隔缺损封堵治疗适应证的筛选和评价

Assessment of secundum atrial septal defect before transcatheter closure by transesophageal echocardiography

目的 对继发孔型房间隔缺损 (ASD)形态及整体状况进行定量评分 ,从而对欲行介入封堵的ASD术前筛选和术中监测作标准化评价。方法 2 10例经临床及超声心动图等检查确诊的ASD患者 ,所有病例采用Amplatzer封堵器封堵 ,术前行经食管超声心动图 (TEE)检查并根据ASD的大小、形态、位置及周边结构进行评分 ,并据此对ASD进行评价。结果 2 0 4例封堵成功 ,TEE测量ASD最大径 4～ 3 1mm[平均 (19.7± 6.3 )mm ] ,选用封堵器大小 10～ 3 6mm [平均 (2 3 .8± 6.6)mm ]。 6例失败。ASD评分≤ 6分为封堵适应证 ,7～ 9分为相对禁忌证 ,10～ 12分为封堵禁忌证。结论 TEE是诊断ASD最佳影像学检查方法 ,应用TEE评分系统可对ASD封堵适应证作术前筛选。

Objective To establish an standardized scoring system for secundum atrial septal defect(ASD) before percutaneous transcatheter closure and to testify this system. Methods Two hundreds and ten patients with pure secundum ASD were considered for Amplatzer occluder device implantation. Transesophageal echocardiography (TEE) was performed before the intervention therapy and meanwhile the anatomy of ASD was given a score according to its diameter,shape,location in order to appreciate its suitability for interventional therapy. Results Two hundreds and four cases were implanted successfully with Amplatzer device and 6 failed. The maximal diameter of the ASD ranged from 4 to 31 mm[( 19.7 ± 6.3 )mm], with Amplatzer occluder selected of 10 to 36 mm[( 23.8 ± 6.6 )mm] accordingly. ASD score ≤6 was considered as excellent candidate for transcatheter closure, whereas score between 7 to 9 was relatively difficult to close and score from 10 to 12 was absolutely unclosable.Conclusions TEE was an optimal imaging technique to evaluate ASD anatomy, using TEE score system, the proper cases for transcatheter closure can be appreciated.