不同体位经食管超声引导下微创封堵干下型室间隔缺损38例临床分析

Transesophageal echocardiography guided mini-invasive occlusion in different postures for subpulmonic ventricular septal defects in 38 cases

目的比较平卧位和右侧卧位经食管超声(transesophageal echocardiography,TEE)引导下左腋下小切口封堵术治疗干下型室间隔缺损(ventricular septal defect,VSD)的安全性和有效性。方法 38例干下型VSD患者行VSD封堵手术,术中分别行平卧位TEE和右侧位TEE检查,比较2种体位下相同多切面VSD直径、VSD部位、有无主动脉瓣脱垂、瓣膜反流情况及VSD与主动脉瓣的距离。结果术中平卧位下TEE测量的VSD直径[(5.10±1.23)mm]、VSD与主动脉瓣距离[(1.52±0.90)mm]、主动脉瓣轻度反流[(0.71±0.22)cm^2]和三尖瓣轻度反流[(1.02±0.21)cm^2]与右侧卧位下测量值[(5.24±1.56)mm、(1.70±0.50)mm、(0.81±0.40)cm^2、(1.04±0.16)cm^2]比较差异无统计学意义(P>0.05),2种体位下TEE证实VSD均为干下型;经左腋下小切口成功封堵36例,2例因新发中度主动脉瓣反流改为体外循环下手术成功;随访3~24个月,封堵成功的36例患者无明显瓣膜反流、残余分流,未发生封堵器脱落、移位、房室传导阻滞等并发症。结论体位变化对TEE相同多切面监测结果无明显影响,右侧卧位时TEE引导封堵治疗直径≤8mm的干下型VSD安全、有效。

Objective To compare the security and efficiency of transesophageal echocardiography （TEE） in supine posture and right lateral posture in monitoring left subaxillary small incision occlusion for subarterial ventricular septal defect （VSD）. Methods Thirty-eight cases of subpulmonic VSD underwent mini-invasive occlusion under TEE in supine posture and right lateral posture to compare the VSD diameter, VSD site, aortic valve prolapse, valvular regurgitation and the distance between VSD and aortic valve of the same cross section in two postures. Results The VSD diameter （（5.10±1.23） mm）, the distance between VSD and aortic valve （（1.52±0.90） mm）, mild aortic valve regurgitation （（0.71±0. 22） cm^2） and tricuspid regurgitation （（1. 02 ±0. 21） cm^2） on TEE in supine posture showed significant differences in comparison with those in right lateral posture （（5.24±1.56） mm, （1.70±0.50） mm, （0.81±0.40） cm^2 , （1.04±0. 16） cm^2） （P〉0. 05）. TEE in both postures confirmed that VSD was subarterial type, and there were no significant differences in the distance between VSD and aortic valve and valvular regurgitation between two postures （P〉 0. 05）. Left subaxillary small incision occlusion was successfully performed in 36 cases, and the other 2 cases converted to surgery under extracorporeal circulation due to moderate aortic valve regurgitation. The follow-up survey for 3 to 24 months showed no obvious valvular regurgitation, residual shunt, occlude abscission, shift, or atrio-ventrieular block. Conclusion The different posture has no obvious influence on the TEE monitoring results, and TEE guided occlusion in right lateral posture is safe and effective for subarterail VSD 48 mm in diameter.