单纯经食管超声心动图引导下经皮房间隔缺损封堵术的疗效分析

Efficacy of percutaneous closing atrial septal defect guided by transesophageal echocardiography

目的分析单纯经食管超声心动图引导下经皮行房间隔缺损封堵术的临床资料,评价方法的安全性和有效性。方法:回顾性分析2017年6月至2018年6月采用经食道超声心动图引导经皮房间隔缺损封堵术患者共16例,操作均在普通手术室进行,单纯采用经食道超声心动图引导,在全身麻醉下,经股静脉穿刺封堵房间隔缺损。食道超声全程监测封堵全过程并评估手术效果。所有患者均在术后1个月、6个月接受经胸超声心动图复查。结果共14例患者封堵成功,1例患者术中封堵器释放后超声心动图提示封堵器靠近下腔边缘存在大量分流,封堵器收入鞘管再次释放后仍存在残余分流,调整为经右胸小切口成功释放封堵伞,另一例术后7日出院前复查超声心动图提示封堵器脱落位于右心室内,再次行房间隔缺损修补术。随访过程中均未见明显并发症。结论经食道超声心动图引导下可以完成大多数房间隔缺损经皮封堵术,避免放射线可能引起伤害,取得良好的临床应用效果。

Objective To analyze the clinical data of percutaneous atrial septal defect closured guided by transesophageal echocardiography,and to evaluate the safety and efficacy of this method.Methods:A retrospective analysis of 16 patients with atrial septal defect were closed by percutaneous and transesophageal echocardiography guided from June 2017 to June 2018 was performed in the general operating room.Transesophageal echocardiography was used alone.Under general anesthesia,the atrial septal defect were closed by femoral vein puncture.Esophageal ultrasound was used to monitor the whole process of the closure and evaluate the surgical results.All patients underwent transthoracic echocardiography at 1 month and 6 months after surgery.Results A total of 14 patients were successful.In one patient,echocardiography showed that there was a large amount of shunt near the edge of the inferior cavity after the occluder was released.The occluder was still released after the sheath was released again.The closed umbrella was successfully released through the small incision in the right chest.Another case was examined by echocardiography before the hospital on the 7th.The occlusion device was placed in the right ventricle and the atrial septal defect was repaired again.No significant complications were observed during follow-up.Conclusion Transesophageal echocardiography can guided the percutaneous closure of most atrial septal defect,avoiding radiation damage and achieving good clinical application.