TEE指导下介入封堵在VSD封堵术中的应用

Application of Interventional Closure Under the Guidance of TEE in VSD Closure Surgery

本研究探讨经食管超声心动图(TEE)引导下实施介入封堵术治疗室间隔缺损(VSD)的临床效果。选取53例单纯膜周型VSD患者作为研究对象进行回顾性分析,其中29例患者采用TEE引导下经股动脉逆行性插管完成VSD封堵术(研究组)、24例患者采用传统的放射线下建立动静脉通道实施经导管VSD介入封堵术(传统组)。对比两组患者的手术操作时间、封堵器型号大小,围手术期及术后并发症,手术前后患者左心功能的超声心动图指标。结果显示,研究组的封堵器型号大小与传统组比较,差异无统计学意义(P>0.05);研究组的手术操作时间短于传统组(P<0.05);术后3个月、术后6个月,两组患者的Tie指数、LVEDV、LVESV、E峰、A峰测定值较本组术前均显著降低(P<0.05),LVEF测定值较本组术前均显著升高(P<0.05)。TEE引导下经股动脉逆行性插管完成VSD封堵术与传统的放射线下建立动静脉通道实施经导管VSD介入封堵术的效果差异不大,但前者简化了手术操作,同时减少了X线损害。

This study investigated the clinical effect of transesophageal echocardiography(TEE)-guided interventional closure surgery for ventricular septal defect(VSD).53 patients with simple perimembranous VSD were selected for retrospective analysis.Among them,29 patients underwent VSD occlusion through TEE-guided retrograde intubation through the femoral artery(study group),and 24 patients underwent traditional radiotherapy,the arteriovenous channel was established to perform transcatheter VSD interventional closure surgery(traditional group).The operation time,size of occluder,perioperative and postoperative complications,and echocardiographic indexes of left ventricular function of patients before and after surgery were compared between the two groups.The results showed that there was no significant difference in the size of the occluder between the research group and the traditional group(P>0.05),and the operation time of the research group was shorter than that of the traditional group(P<0.05).At 3 and 6 months after operation the measured values of Tie index,LVEDV,LVESV,peak E and peak A in the two groups were significantly lower than those before operation in the same group(P<0.05),and the measured values of LVEF were significantly higher than those in the same group.TEE-guided retrograde femoral artery intubation to complete VSD closure surgery is not much different from that of establishing arteriovenous passages under traditional radiation to implement transcatheter VSD interventional closure surgery,but the former simplifies surgical procedures and reduces X-ray damage.