超声心动图在房间隔缺损经皮介入封堵术筛选中的应用价值

Multiple Echocardiographic Views in the Screening for the Candidates for Percutaneous Interventional Closure of Atrial Septal Defect

目的:验证使用多个超声心动图切面在筛查房间隔缺损(ASD)经皮介入封堵术的应用价值。方法:选取深圳市人民医院2016年1月至2019年5月期间收治的34例年龄4~53岁的继发性ASD患者进行经皮介入封堵术。术前行超声心动图多切面检查:(1)胸骨旁四腔心切面;(2)胸骨旁大动脉短轴切面;(3)剑突下两房心切面;用于测量缺损大小和重要的边缘支撑结构。结果:其中1例患者由于ASD缺损较大,被排除在外,其余33例患者中ASD缺损尺寸从4~34 mm不等,并在术中使用了腰部直径12~40 mm的ASD封堵器。相关分析显示ASD封堵器腰部直径随ASD缺损的增加而增大,呈正线性趋势。Pearson相关系数r=0.837,P=0.00。根据α=0.05的水平,可以认为ASD封堵器腰部直径与ASD大小呈正线性关系。超声心动图显示封堵器未出现摇摆和脱位、残余分流和明显的房室瓣反流,也未出现严重心律失常。结论:超声心动图多切面、特别是三切面可以更详细观察ASD的几何形态,更清晰地显示邻近结构,对ASD经皮介入封堵术中封堵器的选择具有重要指导意义。

Objective To validate the role of using multiple echocardiographic views in visualizing the geometry of atrial septal defect(ASD)as well as screening candidates for interventional device occlusion for ASDs.Methods Thirty-four patients aged from 4 to 53 years,with secundum ASD,underwent percutaneous interventional device occlusion of defect.Multiple echocardiographic views:1.parasternal four-chamber view,2.parasternal great vessel short-axial view and 3.subcostal bi-atrial view were used to measure defect size and to determine important rims supporting structures.Results Single case failed to the procedure by multiple attempts due to large ASD,excluded from this study and 33 patients with ASDs had completed the procedure,with defect sizes of 4 mm to 34 mm in patients with ASD were measured by pre-closured echocardiography and ASD occluders of waist size of 12 mm to 40 mm were deployed during procedure.The scattergram illustrated ASD occluder waist size increased with the increase of ASD defect and showed the trend of linear.Pearson correlation coefficient of r=0.837,P=0.00.According toα=0.05 level,can think has a positive linear relationship between ASDs occluder waist size and ASDs size.Neither there was an occluder rocking and dislocation,a residual shunting and a significant atrio-ventricular valve regurgitation determined bypost-closured echocardiography,nor onset of severe arrhymia.Conclusion The role of multiple views,especially three views of echocardiography in pre-closure may more intuitively observe the ASD geometry and more definitely visualize the adjacent structures,which may guide the selection of occluders’type and size during interventional occlusion of ASDs.