经食管超声心动图与经胸超声心动图引导下继发孔型房间隔缺损封堵疗效比较

Effect comparison of percutaneous ostium secundum defect closure guided by transesophageal and transthoracic echocardiography

目的比较经食管超声心动图(transesophageal echocardiography,TEE)与经胸超声心动图(transthoracic echocardiography,TTE)引导行经皮介入封堵术治疗继发孔型房间隔缺损(ostium secundum defect,OSD)的临床效果。方法选择84例继发孔型OSD患者,术前行TTE及TEE检查。根据术中影像学引导技术的不同分为TEE组(44例)和TTE组(40例),分别在TEE和TTE引导下行经皮介入封堵术。比较两组围术期指标、封堵成功率、一次封堵器选择成功率及术后并发症情况。结果两组患者封堵手术均成功。TEE及TTE测量OSD最大内径值存在统计学差异(P<0.05),而两者测量房顶缘残端、主动脉根部残端以及心房总长度等参数比较差异均无统计学意义(P>0.05)。TEE组手术时间、心内操作时间少于TTE组(P<0.05),一次封堵器选择成功率高于TTE组(P<0.05),而两组住院时间及封堵成功率比较均无统计学差异(P>0.05)。所有患者术后随访12个月,均无心包积液及血管损伤发生。TEE组发生残余分流及皮下气肿各1例,TTE组发生胸腔积液及皮下气肿各1例,两组比较差异无统计学意义(P>0.05)。结论TEE引导下行经皮封堵术治疗继发孔型OSD,测量参数准确,操作时间较短,封堵效果满意,安全性良好。

Objective To compare the clinical effects of percutaneous interventional closure guided by transesophageal echocardiography(TEE)and transthoracic echocardiography(TTE)for ostium secundum defect(OSD).Methods A total of 84 OSD patients were collected and performed examination of TEE and TTE before the surgery.According to imaging guidance technique during the operation,all cases were divided into TEE group(44 cases)and TTE group(40 cases),and performed interventional closure guided by TEE and TTE respectively.The peri-operative index,the rate of closure,right occluder selection and complications were com-pared between the two groups.Results All the interventional occlusion surgery was successful in both groups.There was a statistical difference in measuring the maximum inner diameter of OSD(P<0.05),while not in the range of lower edge to roof,aortic root stump and total atrial length(P>0.05)between TEE and TTE technique.Compare to TTE group,the operation time and inner heart operating time was shorter,and the right occluder selection rate of once time was higher in the TEE group(P<0.05),but there was no statistical difference in hospitalization time and closure rate between the two groups(P<0.05).All cases were followed up for 12 months without pericardial effusion and vascular injury.Postoperative com-plication of residual shunt and subcutaneous emphysema was found in one case respectively in TEE group,pleural effusion and subcutaneous emphysema in one case respectively in TTE group,and there was no signifi-cant difference between the two groups(P>0.05).Conclusion The percutaneous ostium secundum de-fect closure guided by TEE can achieve an ideal effect with accurate measurement parameters,shorter opera-tion time,better closure effect and good safety.