经食管超声心动图引导下经胸小切口行漏斗部室间隔缺损封堵术的疗效分析

Clinical Outcomes of Transesophageal Echocardiography-guided Occlusion of Infundibular Ventricular Septal Defect via Minithoracotomy

目的评价经食管超声心动图引导下经胸小切口行先天性心脏病漏斗部室间隔缺损封堵术的临床疗效和安全性。方法回顾性分析2013年1~6月河北省儿童医院21例漏斗部室间隔缺损患儿经食管超声心动图引导下经胸小切口行漏斗部室间隔缺损封堵术的临床资料,其中男10例、女11例,年龄8~24（16±8）个月,体重（9±3）kg,室间隔缺损大小（4.5±2.5）mm。经食管超声心动图引导下完成21例经胸小切口漏斗部室间隔缺损封堵术。用经食管超声心动图评估封堵器的位置、对房室瓣和主动脉瓣的影响以及有无残余分流。结果无围术期死亡和并发症发生。21例室间隔缺损患儿中20例成功封堵,成功率95.2%。其中1例因缺损太大,转为体外循环下直视室间隔缺损修补术。安置封堵器时间（32±16）min,封堵器大小（5±3）mm;住院时间6~8 d。所有患者术后随访3~6个月,随访期间超声心动图提示：封堵器回声清晰,位置正常,无轻度以上残余分流和瓣膜反流。结论经食管超声心动图引导下经胸小切口行漏斗部室间隔缺损封堵术易于操作、疗效确切、安全可靠。

Objective To investigate clinical outcomes and safety of transesophageal echocardiography （TEE）-guided occlusion of infundibular ventricular septal defect （VSD） via minithoracotomy. Methods Clinical data of 21 pediatric patients with infundibular VSD who underwent TEE-guided occlusion via minithoracotomy in Children＇s Hospital of Hebei Province from January to June 2013 were retrospectively analyzed. There were 10 male and 11 female patients with their age of 8-24 （ 16 ± 8 ） months and body weight of 9 ± 3 kg. The size of VSD was 4.5 ± 2.5 mm. TEE was used to evaluate the position of the occluder, its influence on the atrioventricular valves and aortic valve, and the presence of residual shunt. Results There was no perioperative death or complication. VSD occlusion was successfully performed in 20 out of 21 patients （95.2%）. One patient received conversion to open VSD repair under extracorporeal circulation because VSD size was too big. Mean time of delivery of oecluders was 32 ± 16 minutes, the size of the occluders was 5± 3 mm, and length of hospital stay was 6-8 days. All the patients were followed up for 3-6 months after discharge. During follow-up, echocar- diography showed clear echo and normal position of the occluders, and there was no mild or more severe residual shunt or valvular regurgitation. Conclusion TEE-guided occlusion of infundibular VSD via minithoracotomy is easy to perform and safe with satisfactory clinical outcomes.