经食管超声心动图在先天性心脏病微创封堵术中的应用研究

Application of transesophageal echocardiography in surgical micro-invasive congenital heart disease occlusion

目的探讨经食管超声心动图在先天性心脏病外科微创封堵术中的应用价值。方法 298例先天性心脏病患者在经食管超声心动图引导下进行微创封堵治疗,包括172例继发孔房间隔缺损采用经胸小切口封堵治疗术,34例继发孔房间隔缺损采用经皮封堵治疗术,63例室间隔缺损采用经胸小切口微创封堵术,29例采用动脉导管未闭封堵术+体外循环辅助下心内直视矫正术。术后3 d、3个月、6个月、1 a采用经胸超声心动图定期随访疗效。结果 172例继发孔房间隔缺损经胸小切口封堵治疗中,13例改为经体外循环辅助下心内直视修补术,余均封堵成功。34例继发孔房间隔缺损采用经皮封堵治疗术中,27例封堵成功,7例改为经胸小切口封堵成功。63例室间隔缺损经胸微创封堵治疗中,7例改为体外循环辅助下心内直视修补术。合并动脉导管未闭患者中,11例合并Fallot四联症,7例合并肺动脉瓣狭窄,11例合并部分型心内膜垫缺损,其中动脉导管未闭全部封堵成功,术后房、室水平无分流。术后随访1 a,封堵成功患者无封堵器相关并发症发生。结论经食管超声心动图能够有效地指导先天性心脏病的微创封堵治疗。

Objective To discuss the the application value of transesophageal echoxardiography （TEE） in surgical micro - invasive congenital heart disease （CHD） occlusion. Methods 298 patients with CHD were performed micro - invasive occlusion guided by transesophageal echocardiography （TEE） , including 172 cases with secondary ASD that were given transthoracic mini- mal invasive closure, 34 cases with secondary ASD that were given percutaneous closure, 63 cases with VSD that were given tran- sthoracic minimal invasive closure, and 29 cases given closure of patent ductus arteriosus （PDA） with open -heart diorthosis ai- ded by extracorporeal circulation. All patients were followed up regularly by thransthoracic echocardiography 3 days, 3 months, 6 months, and one year after operation. Results For 172 cases with secondary ASD that were given transthoracic minimal invasive closure, except for 13 cases of them that were later given open -heart diorthosis aided by extracorporeal circulation, others were successfully closed. For 34 cases with secondary ASD that were given percutaneous closure, 27 cases were successfully closed and 7 cases were successfully closed through transthoracic minimal invasive closure instead. For 63 cases with VSD that were giv- en transthoracic minimal invasive closure, 7 cases were operated by open - heart diorthosis aided by extracorporeal circulation in- stead. For 29 cases patients with PDA, Fallot tetralogy occurred in 11 cases, pulmonary artery valvular stenosis occurred in 7 ca- ses and partial endocardial cushion defect occurred in 11 cases; the PDA symptoms were successfully occluded guided by TEE and the interatrial and ventricular shunt were not found after operation. During the one year＇ s follow - up after operation, the complications related to closure devices were not found. Conclusion TEE can effectively guide the surgical micro - invasive oc- clusion for patients with CHD.