实时三维经食管超声心动图在成人多孔房间隔缺损介入封堵术中的应用价值

Application value of real-time three-dimensional transesophageal echocardiography in multiple atrial septal defect device closure

目的探讨实时三维经食管超声心动图在成人多孔房间隔缺损介入封堵术中的应用价值。方法回顾性分析2013年3月至2015年3月于首都医科大学附属北京安贞医院成功接受经导管介入封堵术的25例多孔房间隔缺损患者的超声心动图资料，其中14例患者术前行二维经胸超声心动图检查（二维超声组），11例患者术前行实时三维经食管超声心动图检查（三维超声组）。2组均根据超声心动图结果明确缺损的形态、数日以及解剖毗邻，并据此选择封堵器的大小及数目。2组均采用二维经胸超声心动图行术中监测及术后随访。结果所有患者均使用Amplatzer型封堵器。二维超声组14例患者均存在双孔房间隔缺损（术前发现12例，术中发现2例），共28处缺损，成功置入14枚封堵器。三维超声组术前提示10例患者存在双孔房间隔缺损，1例患者为三孔房间隔缺损，共23处缺损，成功置入12枚封堵器。三维超声组手术时间、透视时间均明显短于二维超声组[（42±3）min比（47±6）min、（3．5±0．7）min比（4．6±1．2）min]，差异均有统计学意义（均P〈0．05）。在多孔房间隔缺损的彤态、数目以及解剖毗邻的评价方面，实时三三维经食管超声心动图的图像比二维经胸超声心动图的图像更加直观，能够清晰地显示解剖结构.结论与二维经胸超声心动图相比，实时三维经食管超声心动图能够对多孔房间隔缺损的数目、形态、化置、孔间距以及周边的毗邻关系提供更加准确的信息，尤其对于术前怀疑多孔房间隔缺损的患者，行实时三维经食管超声心动图检查非常必要。

Objective To explore the application value of real-time three-dimensional transesophageal ech-ocardiography（RT-3D-TEE） in multiple atrial septal defect （ASD） device closure. Methods Totally 25 cases of ASD device closure from March 2013 to March 2015 in Beijing Anzhen Hospital, Capital Medical University were enrolled, including 14 patients having two-dimensional echocardiography （2D-TEE group） and 11 patients having RT-3D-TEE （3D-TEE group） before operation. Forms, positions, numbers and anatomical adjaeencies of defects and the adequacy of septal rims for device closure in two groups were obtained from the 2D-TEE and RT-3D-TEE, respectively. In all patients undergoing transcatheter closure, the intraoperative monitoring and follow-up was con- ducted by two-dimensional echocardiography. Results All patients were placed Amplatzer septal occluder devices. In 2D-TEE group, all of 14 cases had double ASD（ 12 cases were diagnosed before operation, 2 cases were diagnosed during operation） ; totally 28 defects were found and 14 Amplatzer occluder devices were successfully placed. In 3D-TEE group, 10 cases were diagnosed with double ASD before operation; 1 case had triple ASD; totally 23 defects were found; 12 Ampiatzer occluder devices were successfully placed. The operation time and X-ray time in 3D-TEE group were significantly shorter than those in 2D-TEE group[ （42 ±3） min vs （47 ±6） min, （3.5 ±0.7） min vs （4. 6 ±1.2）mini （P 〈0. 05）. The RT-3D-TEE provided more visual and clear images than 2D-TEE in the evaluation of forms, positions, numbers and anatomical adjaeencies of muhiple ASD. Conclusions The RT-3D-TEE can provide more accurate informations of forms, positions, numbers and anatomical adjacencies for the diagnosis of multiple ASD, regarding the amounts, shapes, locations, hole pitch and anatomy adjacency of defects than 2D-TEE in patients with ASD. Patients with multiple ASD are suggested to have RT-3D-TEE examination before operations.