经食管实时三维超声引导继发孔型房间隔缺损封堵的临床疗效研究

Clinical efficacy of transesophageal real-time three-dimensional ultrasound monitoring the closure of secondary foraminous atrial septal defect

目的研究经食管实时三维超声心动图监测和引导继发孔型房间隔缺损(ASD)封堵的临床疗效。方法收集2018年10月至2020年6月于安徽医科大学第一附属医院心血管外科确诊并采用经食管实时三维超声引导封堵的51例继发孔型房间隔缺损患者资料,就手术失败率及术后并发症的发生、封堵器的选择、术后随访患者心脏结构和功能的变化等临床资料进行回顾性分析。结果51例患者中成功置入Amplatzer双盘封堵器49例,手术成功率96%。术中二维测量ASD最大径为(18.34±6.29)mm,三维测量ASD最大径为(23.60±7.38)mm,两组数据之间的线性相关分析表明三维测量最大径与术中所选用封堵器型号的相关性更好。封堵治疗术后有2例封堵器边缘可见星点状残余分流,未经特殊处理,术后1月随访时分流消失。术后随访过程中患者心脏的结构和功能均进行性改善,手术疗效肯定。结论经食管实时三维超声心动图能够有效和直观地监测、引导继发孔型房间隔缺损的封堵治疗,具有重要的临床疗效及应用价值。

Objective To investigate the clinical efficacy of real-time three-dimensional echocardiographic monitoring and guided closure of the ostium secundum atrial septal defect(ASD).Methods A total of 51 patients with a secundum type atrial septal defect diagnosed at the Department of cardiovascular surgery,the First Affiliated Hospital of Anhui Medical University between October 2018 and June 2020 and using transesophageal real-time three-dimensional ultrasound-guided closure were recruited,and clinical data were retrospectively reviewed with respect to the rate of surgical failure and the occurrence of postoperative complications,the choice of an occluder,and changes in cardiac structure and function in patients with postoperative follow-up.Results The Amplatzer double disc occluder was successfully placed in 49 of 51 patients,and the procedure was successful in 96%.The maximum diameter of measured ASD was(18.34±6.29)mm in the two dimensions intraoperatively and(23.60±7.38)mm in the three dimensions,and linear correlation analysis between the two sets of data indicated that the three-dimensional measured maximum diameter correlated better with the occluder model chosen intraoperatively.Occlusion therapy there were 2 cases with a stellate residual shunt visible at the occluder edge without specific treatment,and the shunt disappeared at the 1-month postoperative follow-up.Both the structure and function of the patient's heart improved gradually during postoperative follow-up,and the efficacy of surgery is certain.Conclusion Transesophageal real-time three-dimensional echocardiography can effectively and intuitively monitor and guide the closure treatment of secondary foraminous atrial septal defect,which has important clinical efficacy and application value.