心外膜超声心动图在肌部室间隔缺损镶嵌治疗中的应用价值

Application value of intraoperative epicardial echocardiography in hybrid approach to perventricular device closure of muscular ventricular septal defect

目的探讨心外膜超声心动图(IEE)在肌部室间隔缺损(mVSD)镶嵌治疗中的应用价值。方法选取2014年1月至2018年3月就诊于大连医科大学附属大连市儿童医院,经胸超声心动图(TTE)诊断为单纯mVSD的患儿8例。所有患儿均在IEE引导下完成经胸mVSD镶嵌封堵治疗,并于术后即刻评价封堵效果,术后1、3、6、12个月定期复查TTE、心电图、尿常规,观察封堵器有无移位、脱落,有无心律失常及溶血等并发症发生。结果8例患儿均在IEE引导下经胸镶嵌封堵成功,其中1例存在残余分流。术后1、3、6、12个月随访,封堵器均无脱落及移位,无心律失常及溶血发生,残余分流患儿在术后6个月复查时残余分流消失。结论IEE引导镶嵌治疗mVSD具有清晰显示mVSD全貌、准确引导镶嵌治疗过程、受操作位置和角度限制较小、无辐射、无需造影剂、创伤相对较小(避免体外循环)等优势,在mVSD镶嵌治疗中具有良好的临床应用价值。

Objective To evaluate the application value of intraoperative epicardial echocardiography(IEE)in the hybrid approach to perventricular device closure of muscular ventricular septal defect(mVSD).Methods Eight patients were diagnosed with isolated mVSD by preoperative transthoracic echocardiography(TTE)at the Heart Center of Children′s Hospital of Dalian Medical University from January 2014 to March 2018.All patients with mVSD were closed via the hybrid approach under IEE guidance with specific devices.The effects of the procedure was evaluated by IEE.Follow-up study was performed at 1 month,3 months,6 months,and 12 months after operation by TTE,electrocardiogram,and routine urine tests to observe whether complications such as sealing device migration or loss,arrhythmia,and hemolysis occurred.Results All cases were occluded successfully via the hybrid approach under IEE guidance with specific devices,and one case had residual shunt less than 2 mm,which disappeared 6 months after surgery.All patients underwent TTE,electrocardiogram,and routine urine tests at 1 month,3 months,6 months,and 12 months after operation,and no notable residual shunt,occluderloss or migration,or arrhythmia was found.Conclusion IEE has a high value in the hybrid approach closure of mVSD,and the image of mVSD by IEE is clearer than that by transesophageal echocardiography(TEE).IEE is easy to operate,and avoids the use of cardiopulmonary bypass,radiation,and contrast agents.