食管超声心动图在引导VSD封堵术中的应用价值

Application value of transesophageal echocardiography in guiding VSD closure operation

目的探讨食管超声(TEE)在监测经胸微创室间隔缺损(VSD)封堵术前、术中的临床应用价值。方法收集2014年3月至2015年5月于徐州市儿童医院心脏外科行经胸微创封堵的VSD患儿62例,患儿术前均接受TTE检查,以明确VSD位置、类型、大小及边缘情况,明确VSD微创封堵术可行性,并初步选择合适的VSD封堵器。术中在TEE引导下确定荷包位置,实时动态监测封堵器放置过程,并立即判断手术疗效。术后3~5天行经胸超声(TTE)检查恢复情况。结果 62例患儿全部封堵成功,术中存在残余分流2例,封堵器内渗漏3例,2例Ⅱ度房室传导阻滞。患儿均于术后3~5天出院。术后1、3、6、12个月随访,无封堵器脱落移位,无瓣膜反流加重及房室传导阻滞等并发症出现,术后6个月复查残余分流及渗漏消失。结论 TEE在经胸微创封堵术前定位、术中引导及术后即刻评价中均起到重要作用,值得临床推广。

Objective To study the clinical application value of transesophageal echocardiography（ TEE） in monitoring minimal invasive thoracic esophagus ventricular septal defect（ VSD） block before and during operation. Methods Sixty-two cases of VSD treated with minimal invasive thoracic esophagus VSD block in cardiac surgery department in Xuzhou Children＇s Hospital from March 2014 to May 2015 were collected. All patients were examined by TTE before operation in order to make clear VSD location,type,size and edge conditions,to determine the feasibility of VSD minimal invasive closure,and to choose the right VSD occluder. Detection of pocket location,real time dynamic monitoring of occluder implantation and immediate determination of operation effect were done during operation under guidance of TEE. Postoperative recovery condition was determined by TTE at 3 to 5 day after surgery. Results All of 62 cases were occluded successfully. Two cases had residual shunt during operation. Three cases had occluder internal leakage,and 2 cases had Ⅱ degree atrioventricular block. All cases were discharged at 3 to 5 day after operation. Postoperative follow-up for 1 month,3 months,6 months and12 months revealed no incidence of complications such as occluder malposition,increased valvular regurgitation and atrioventricular block.Postoperative check in 6 month found that residual shunt and leakage disappeared. Conclusion TEE plays an important role in preoperative localization,intraoperative guidance and immediate postoperative evaluation for minimal invasive thoracic block surgery,and it is worth clinical promotion.