超声引导下经皮介入治疗1010例结构性心脏病的临床疗效及应用价值

Clinical efficacy and application value of percutaneous interventional treatment for 1010 patients with structural heart diseases under guidance of ultrasound

目的探讨超声引导下经皮介入治疗结构性心脏病的临床疗效及应用价值。方法回顾性分析我院2015年12月2日至2019年12月31日经皮超声引导下封堵治疗1 010例结构性心脏病患者的临床资料,其中男360例、女650例,年龄1~50岁。房间隔缺损692例(中央型603例、合并动脉导管9例、筛孔型80例),卵圆孔未闭116例,室间隔缺损25例(合并房间隔缺损3例),动脉导管未闭132例,肺动脉瓣狭窄32例(合并房间隔缺损3例),主肺动脉窗1例,主动脉窦瘤破裂3例。所有患者术前均经胸超声心动图(TTE)明确诊断,术中在TTE或经食管超声心动图(TEE)引导下由股动脉或股静脉入路以完成治疗。术后复查心脏超声、心电图及胸部X线片。结果 1 005例患者取得满意效果,1例室间隔缺损封堵失败,在直视下修补,5例患者术后发生封堵器脱落(3例房间隔缺损开胸取伞、修补,1例房间隔缺损在X线下取伞后完成封堵,1例动脉导管未闭开胸取伞并缝扎),2例肺动脉瓣狭窄球囊扩张后肺动脉瓣轻度反流,2例室间隔缺损有少量残余分流,术后3个月复查时分流消失,1例右束支传导阻滞,1周后消失。随访1~24个月,3例筛孔型房间隔缺损1年后复查微量分流,封堵器位置良好,肺动脉瓣跨瓣压差显著缩小,无溶血、心律失常、栓塞、腱索断裂等并发症。结论 TTE或TEE引导下经皮股动、静脉治疗结构性心脏病安全有效、创伤小、无辐射及造影剂损伤,具有显著的临床疗效及应用价值。

Objective To investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound.Methods The clinical data of 1010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2,2015 to December 31,2019 were retrospectively reviewed,including 360 males and 650 females,aged 1-50 years.There were 692 patients of atrial septal defect(603 with central type,9 combined with arterial catheter,80 with ethmoid type),116 patent foramen ovale,25 ventricular septal defects(3 combined with atrial septal defect),132 patent ductus arteriosus,32 pulmonary valve stenosis(3 combined with atrial defect),1 main pulmonary artery window,and 3 aneurysm rupture of aortic sinus.All patients were diagnosed by transthoracic echocardiography(TTE)before operation.Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography(TEE)via the femoral artery or femoral vein.After operation,echocardiography,electrocardiogram and chest radiograph were reexamined.Results Satisfactory results were obtained in 1005 patients,and 1 patient failed to seal the ventricular defect and was repaired under direct vision,occluder detachment occurred in 5 patients after operation(3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired,1 patient of atrial septal defects was closed after removing Amplatzer device,1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured),mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis,a small amount of residual shunt was found in 2 patients with ventricular defect,which disappeared after 3 months of follow-up,and1 patient of right bundle branch block occurred and disappeared after 1 week.After follow-up of 1-24 months,3 patients of ethmoidal atrial septal defect were reexamined with mild shunt.The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced.There was no complication such as hemolysis,arrhythmia,embolism or rupture of chordae tendinae.Conclusion Percutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective,with little trauma,no radiation or contrast agent damage,and has significant clinical efficacy and application values.