超声心动图在Fontan术后管道开窗堵塞术中的应用

Application of echocardiography in the transcatheter closure of Fontan fenestration

目的评价经胸超声心动图(TTE)在经皮心导管关闭Fontan术后管道开窗中的应用价值。方法选取11例Fontan术后管道开窗堵塞术患者术前、术中及术后随访的超声心动图诊断资料。结果11例患者术前超声诊断均正确,超声测量管道开窗大小为(0.41±0.22)cm,心血管造影测得管道开窗大小为(0.50±0.25)cm,二者间高度相关(P<0.01,r=0.93)。术前降主动脉血氧饱和度为(84.42±8.58)%,上腔静脉平均压为(11.27±3.72)mmHg。应用A.G.A公司Amplatzer房间隔缺损堵塞装置进行管道开窗堵塞术,术后降主动脉血氧饱和度为(94.15±8.20)%,较术前明显提高(P<0.05);术后上腔静脉平均压为(14.55±4.20)mmHg,堵塞前后无明显差异(P>0.05)。11例患者均成功堵塞,术后6个月随访,堵塞装置位置良好,无残余分流。结论超声心动图在管道开窗堵塞术的术前诊断、术中监测、术后即刻效果判断及随访中起重要作用,是一种有效的监测手段。

Objective To evaluate the clinical value of echocardiography in the transcatheter closure of Fontan fenestration.Methods A retrospective echocardiography review of 11 children in the transcatheter closure of the patent fenestration after Fontan procedure was conducted.Results All 11 patients were diagnosed correctly by Doppler echocardiography.The diameter of the patent fenestration measured by echocardiography was(0.41±0.22)cm.The diameter of the patent fenestration measured by catheterization was(0.50±0.25)cm(P<0.01,r=0.93).The oxygen saturation of the descending aorta and the mean pressure of the superior vena cava measured by catheterization increased from(84.42±8.58)%before to(94.15±8.20)%(P<0.05)after and from(11.27±3.72)%before to(14.2±2.15)mmHg after the occlude procedure(P>0.05).11 children(100%)were successful implantation of Amplatzer occlusion device.During a median follow-up of six months,11 devices were in good position and no residual shunt.Conclusion Doppler echocardiography was valuable for the diagnosis before the procedure,the monitor of implantation of the devices during the procedure,and evaluating the therapeutic effects,which was an effective guidance technique.