经胸超声心动图、经食道超声心动图在不同残缘类型房间隔缺损封堵术前筛查中的应用

Application of transthoracic echocardiography and transesophageal echocardiography in preoperative screening of different residual types of atrial septal defect occlusion

目的探讨经胸超声心动图(TTE)、经食道超声心动图(TEE)在不同残缘类型房间隔缺损(ASD)封堵术前筛查中的应用价值。方法回顾性分析2020年1月至2021年12月在聊城市第二人民医院接受房间隔缺损介入治疗的120例ASD患者的临床资料。患者术前均行TTE、TEE检查,根据术前TTE检查结果将患者分为两组:缺损残缘回声强、摆动幅度<5 mm者归入A组(n=60);缺损残缘回声纤细、摆动幅度≥5 mm者归入B组(n=60)。比较TTE、TEE在测量两组患者房间隔缺损最大径方面的差异,并评估这两种方法测得的缺损最大径与封堵器腰部直径之间的相关性。结果A组中TTE和TEE测量房间隔缺损最大径差异无统计学意义(P>0.05),而B组中差异有统计学意义(P<0.01)。在A组患者中,TTE和TEE测量ASD最大径与封堵器腰部直径的相关性均较好(r=0.993,0.991);而B组患者中,TEE测量ASD最大径与封堵器腰部直径的相关性较高(r=0.995),明显大于与TTE测值的相关性(r=0.897)。A组患者封堵器腰部直径与TTE、TEE测值差值均较小,差异无统计学意义(P>0.05);B组患者封堵器腰部直径与TEE测量值差值明显小于与TTE测量值的差值(P<0.01)。结论对于残留回声强、摆动幅度小的房间隔缺损患者,TTE和TEE具有相当的应用价值,可以在病例筛选中使用TTE代替TEE;而对于残留回声菲薄、摆动幅度大的房间隔缺损患者,需要进一步行TEE检查,以帮助手术医生更准确地选择适合的封堵器。

ObjectiveTo explore the application value of transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE)in preoperative screening of different residual types of atrial septal defect(ASD)occlusion.MethodsA retrospective analysis was conducted on the clinical data of 120 ASD patients who received interventional treatment for atrial septal defect at the Second People′s Hospital of Liaocheng from January 2020 to December 2021.Patients underwent TTE and TEE examinations before surgery,and were divided into two groups based on the results of the preoperative TTE examination:those with strong echogenicity of the defect margin and swing amplitude<5 mm were classified as group A(n=60);Patients with fine echoes and a swing amplitude of≥5 mm at the defect margin were classified as group B(n=60).The study compared the differences in measuring the maximum diameter of atrial septal defect between two groups of patients using TTE and TEE,and evaluated the correlation between the maximum diameter of the defect measured by these two methods and the waist diameter of the occluder.ResultsThere was no statistically significant difference in the maximum diameter of atrial septal defect measured by TTE and TEE in group A(P>0.05),while there was a statistically significant difference in group B(P<0.01).In group A patients,the correlation between the maximum diameter of ASD measured by TTE and TEE and the diameter of the occluder waist was good(r=0.993,0.991);In group B patients,the correlation between the maximum diameter of ASD measured by TEE and the diameter of the occluder waist was higher(r=0.995),significantly greater than the correlation with TTE measurements(r=0.897).The difference between the waist diameter of the occluder and the values measured by TTE and TEE in group A patients was small and not statistically significant(P>0.05);The difference between the waist diameter of the occluder and the TEE measurement value in group B patients was significantly smaller than the difference with the TTE measurement value(P<0.01).ConclusionsFor patients with atrial septal defect with strong residual echo and small amplitude of oscillation,TTE and TEE have considerable application value and can be used instead of TEE in case screening;For patients with atrial septal defect with thin residual echoes and large oscillation amplitude,further TEE examination is needed to help surgeons more accurately select suitable occluders.