经食管超声在经左侧肋间小切口封堵小儿高位室间隔缺损中的应用价值

Application of transesophageal echocardiography in high ventricular septal defect closure via the small intercostal incision with eccentric occluder in children

目的探讨经食管超声心动图(T EE)在经左侧胸骨旁肋间小切口(≤1 cm )用偏心封堵器封堵小儿高位(流出道及膜高位)室间隔缺损(VSD )中的应用价值.方法经左侧胸骨旁肋间小切口用偏心封堵器封堵小儿高位VSD 48例,手术全过程均在单纯 T EE评估及引导下进行,术前 T EE评估缺损位置、形态、大小,术中定位及引导均完全在超声监测引导下进行,术后即刻给予 T EE全面评估.结果 46例(95 .8%)患儿封堵成功,最大缺损为2 .2~6 .0 (3 .70 ± 0 .90) mm ,偏心封堵器型号4~8 (5 .48 ± 1 .12) mm ,手术时间18~98 (49 .80 ± 16 .71) min .流出道VSD 44例,膜高位VSD 2例. 10例有轻度主动脉瓣膜脱垂,其中5例伴有轻度主动脉瓣反流(AR),术后即刻T EE检查均无AR加重,另1例流出道VSD下缘有隔膜,1例流出道VSD缺损小使用扩张鞘, 1例膜高位VSD更换封堵器,均成功封堵.术后随访6~42个月.术后少量心包积液3例,均在随访中消失,无其他明显并发症.结论在经左侧胸骨旁肋间小切口用偏心封堵器封堵小儿高位VSD中, T EE对缺损评估、术中定位及引导、术后即刻疗效评价均有重要价值,能有效地指导VSD的封堵治疗.

Objective To explore the value of transesophageal echocardiography (TEE) in high ventricular septal defect (VSD) occlusion via a left parasternal ultra-minimal intercostal incision (≤1 cm) with eccentric occluder in children. Methods Forty-eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder. The whole operation, including preoperative evaluation, intraoperative localization and guidance and postoperation evaluation were performed under the guidance of TEE. Results Forty-six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95.8%. The average size of high VSD was 2.2-6.0 (3.70±0.90)mm and the average size of eccentric occluder was 4-8 (5.48±1.12)mm. The average operation duration was 18-98 (49.80±16.71)min. There were 2 cases of peri-membranous high VSD and 44 cases of outlet-typle VSD, of which 10 cases of mild aortic valve prolapses (AVOP), including 5 cases of aortic valve regurgitation(AR). In addition, there was 1 case of replacement of device, 1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect. The 46 cases were followed up for 6 to 42 months, and the pericardial effusion occured in 3 cases and disappeared during follow-up. No other abnormal conditions were found. Conclusions During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder, TEE has an important value in defect assessment, intraoperative localization and guidance, and immediate evaluation of efficacy, and can effectively guide the device occlusion of high VSD.