单纯食管超声心动图引导经右颈内静脉封堵房间隔缺损早期随访结果

Early follow- up results of simple transesophageal echocardiography to guide the right jugular internal vein for closure of atrial septal defect

目的总结单纯食管超声心动图（TEE）引导经右颈内静脉封堵房间隔缺损（ASD）的经验和早期随访结果，探讨其可行性。方法收集2015年2月至2016年2月郑州大学人民医院儿童心脏中心单纯TEE引导经颈内静脉途径ASD封堵患儿24例，其中男女各12例。年龄5～18（12．4±5．6）岁，体质量16～60（34．1±9．6）kg，ASD直径5～20（11．0±2．5）mm。患儿均仅行TEE引导并监测封堵全过程，术后即刻采用TEE评价手术效果，术后24h及1、3、6、12个月行经胸超声心动图、x线胸片及心电图随访。结果24例患儿中23例应用该方法获得成功，封堵器直径（14．5±3．6）mm，手术操作时间（20．5±7．2）min。1例双孔型ASD，封堵大孔后，小孔未完全覆盖，残余5mm分流，经与家属沟通后转为外科侧开胸修补术。术后即刻3例存在微量残余分流，术后即可下床活动，随访时间（5．6±1．2）个月，随访中均未见残余分流、封堵器移位、血管损伤、传导阻滞及心脏穿孔等并发症。结论对部分合适的患儿，单纯TEE引导下经颈内静脉行ASD封堵术具有一定可行性，不仅能避免放射线损伤，而且又能缩短卧床时间和避免下肢制动，早期随访效果良好。

Objective To summarize the preliminary experience and early - stage follow - up results of simple transesophageal echocardiography（TEE） to guide right jugular internal vein for closure of atrial septal defect （ASD）, and to investigate its feasibility. Methods A total of 24 ASD patients （ 12 male, 12 female） treated by transcatheter ASD closure under solely guidance of TEE were summarized in Children Heart Center, People＇s Hospital of Zhengzhou University from February 2015 to February 2016. Mean age,body weight and average diameter of the 24 cases of ASD were 5 - 18 （ 12.4± 5.6） years old, 16 - 60 （34.1 ± 9.6） kg, 5 - 20 （ 11.0 ± 2.5 ） mm, respectively. All patients were treated by right jugular internal vein transcatheter closure under solely guidance of TEE. The efficiency of imme- diate post -operation under TEE was estimated, and follow -ups were done at 24 hours, 1 month,3,6 and 12 months after the procedures by transthoracic echocardiography, X - ray examination and electrocardiogram. Results A total of 23 patients were treated successfully under solely guidance of TEE. The diameter of devices was （ 14.5 ±3.6） mm. The procedural time was （20.5± 7.2） min. One patient who had 2 ASD was treated by traditional thoracic surgery, because the small ASD had 5 mm residual shunt after the procedures. There were 3 cases with trivial residual shunt after the pro- cedures immediately. All patients could move at once after operation. The average follow - up time was （ 5.6 ± 1.2 ） months. No patients suffered from residual shunt, occluder malposition, peripheral vascular injury, pericardial effusion or cardiac perforation during the follow - up. Conclusions For some selected patients, simple TEE guiding right jugular in- ternal vein for closure of ASD is applicable. The method not only prevents injury from radiation, but also shortens the in - bed time and avoid the lower limbs braking,with good early- stage follow- up results are desirable.