室间隔缺损封堵术后超声心动图随访研究

Follow-up of Echocardiography after Transcatheter Closure of Ventricular Septal Defect

目的探讨经胸超声心动图（TTE）在室间隔缺损（VSD）封堵术后随访中的价值。方法用TTE成功实施经皮穿刺VSD封堵术的患者325例,分别于术后1-3 d、1个月、3个月、6个月、1年行TTE复查,以后每年复查1次。结果共植入VSD封堵器326枚,术后1-3 d左心房收缩末期前后径、主肺动脉中段内径、左心室舒张末期前后径、左心室舒张末期容积、左心室射血分数、左心室短轴缩短率均明显低于术前（P〈0.05）;但术前、术后1-3 d右心室舒张末期前后径比较,差异无统计学意义（P〉0.05）。随访时间为（18.2±20.4）个月,VSD修补术后少量残余分流2例,动脉导管未闭封堵术后3 d少量残余分流1例,3个月后分流消失;1例术前无三尖瓣反流,术后3 d三尖瓣中度反流,随访8年,三尖瓣前瓣脱垂合并重度反流。结论 TTE适用于VSD封堵术后大规模长期随访。

Objective To evaluate the value of transthoracic echocardiography（ TTE） in the follow-up after transcatheter closure of ventricular septal defect（ VSD）. Methods Three hundred and twenty-five cases of VSD underwent percutaneous catheter occlusion successfully under TTE. TTE was performed for these patients on the 1st to 3rd day,3rd month,6th month and 1st year after operation,respectively. And then the follow-up was carried out once a year. Results Three hundred and twenty-six occluders were used in the 325 patients. Compared with the preoperative,some indexes were significantly lower at 1-3 days postoperatively（ P〈0. 05）,including left atrial end-systolic systolic（ LAESD）,main pulmonary artery（ MPA）,left ventricular end-diastolic diameter（ LVEDD）,left ventricular end-diastolic volume（ LVEDV）,left ventricular ejection fraction（ LVEF） and left ventricular fraction shortening（ LVFS）. However,there was no significant difference in right ventricular end-diastolic diameter（ RVEDD） between preoperative and postoperative（ P〉0.05）. During the follow-up of（ 18.2 ±20.4） months,2 cases were found slightly residual shunt in the repair of VSD,and one in the occlusion of patent ductus arteriosus with slightly residual shunt completely disappeared 3 months later. One case,without tricuspid regurgitation before operation,experienced moderate tricuspid regurgitation on the postoperative 3rd day,which developed to anterior tricuspid valve prolapsed with severe regurgitation after a follow-up of 8years. Conclusion TTE has important clinical value in the long-term and large-scale follow-up after occlusion of VSD.