经食管超声心动图引导下复杂房间隔缺损封堵的安全性研究

The safety of complicated atrial septal defect closure guided by transesophageal echocardiography

目的 评价经食管超声心动图引导下经颈静脉或经胸小切口封堵较大缺损或下后缘不足房间隔缺损的安全性和有效性。方法 收集2016年1月至2021年1月我院心脏外科收治拟行封堵术的先天性房间隔缺损42例,其中下后缘不足22例,较大缺损(>30 mm)20例,三维超声评估房间隔形状(圆形指数),全超声引导下行经颈静脉或经胸小切口房间隔缺损封堵。出院前、术后半年随访观察心脏结构、血流动力学变化及并发症发生。结果 经颈静脉封堵22例,经胸小切口封堵20例。封堵24小时内脱落1例;与术前比较,封堵后出院前右心房、右心室减小,左心房、左心室增大,肺动脉瓣前向血流速度、三尖瓣反流速度、二尖瓣瓣环E′、二尖瓣瓣环A′均降低,差异有统计学意义(P<0.05)。无新增并发症发生。结论 经食管超声心动图引导下经颈静脉或经胸小切口封堵较大缺损或下后缘不足房间隔缺损是安全、可行的。

Objective To evaluate the safety and feasibility of device closure of atrial septal defects(ASD) with large defects or atrial septal defect with inferior or posterior rim deficiency via jugular vein or minimal intercostal incision under the guidance of transesophageal echocardiography(TEE).Methods From Januray 2016 to January 2021, 42 ASD patients planned for closure procedure in our heart surgery center were enrolled. Of the 42 ASD patients, 22 were insufficient inferior and posterior rim, and 20 patients were large defect(>30 mm). The atrial septal shape(circular index) was assessed using three-dimensional TEE. Echocardiography guided the closure of the atrial septal defect. The changes in cardiac structure, hemodynamics and complications were observed before discharge and after 6 months of operation.Results There were 22 cases of transjugular vein closure and 20 cases of transthoracic small incision closure. One case fell off within 24 hours of closure. Compared with before operation, right atrium and right ventricle were decreased and left atrium and left ventricle were enlarged after occlusion(P<0.05). Moreover, the pulmonary valve forward blood flow velocity, tricuspid regurgitation velocity, mitral valve ring E′, and the cusp valve ring A′ were all decreased(P<0.05). There was no new complications during the follow-up.Conclusions Under the guidance of TEE, it is safe and feasible to occlude the large defects or atrial septal defects with inferior or posterior rim deficiency via transjugular or from minimal intercostal incision.