经食管超声心动图引导经胸微创封堵动脉导管未闭86例

Transthoracic closure of patent ductus arteriosus guided by transesophageal echocardiography: report of 86 cases

目的总结经食管超声心动图引导经胸微创封堵动脉导管未闭的临床经验。方法回顾性分析86例动脉导管未闭封堵手术患者的临床资料,取左胸骨旁第2肋间2~3 cm切口,在食管超声心动图(TEE)实时监测引导下,用动脉导管未闭封堵器行封堵术。结果 81例患者手术按计划完成,5例术中转开胸结扎。手术时间25~140 mm,平均(49±18.88)min;出血量10~150 mL,平均(25.8±26.8)mL;术后住院时间3~22 d,平均(9.66±3.97)d;1例术后心包积液,再次开胸止血。其余术后无封堵器脱落、溶血、肺炎、心律失常、二次开胸、切口感染等并发症,出院前复查未见封堵伞移位、脱落,无明显胸腔积液及心包积液。结论经食管超声心动图引导经胸微创封堵动脉导管未闭安全可靠、手术时间短、创伤小、术后恢复较快,但要严格把握手术指征。

Objective To summarize clinical effect of transthoracic closure of patent ductus arteriosus （PDA） guided by transesophageal echocardiography. Methods Retrospective analysis of the clinical data of 86 cases that received transesophageal echo- cardiography guided left chest parasternal approach minimally invasive occlusion of patent ductus arteriosus was conducted, male 26 ca- ses, female 60 cases;age 1 -51 years old;body mass 7 -70 kg. The patients was given the anesthesia iutubation in operation room and cut at the second intercostal incision of left parasternal. The cases of patent ductus arteriosus were treated with PDA occlude guided by transesophageal eehocardiography. Results 81 cases were all successful ,5 cases were converted to traditional ligation of patent ductus arteriosus. There have no death and blood transfusion. Echoeardiography was used after operation,there were no residual shunt, occluder dislocation, embolism and arrhythmia. Patients were followed up for 1 - 12 months, all patients recovered well. Conclusion Transesoph- ageal echocardiography guided transthoracic closure of patent ductus arteriosus are safety,less trauma, and could short the operation time and faster the postoperative recovery.