食管超声心动图引导下经胸微创封堵先心病的应用

Application of the minimally invasive thoracic esophageal closure guided by Echocardiography in congenital heart disease

目的探讨食管超声心动图引导下经胸微创封堵先天性心脏病(先心病)的疗效。方法本研究组68例简单先心病患儿,术前均行经胸超声心动图检查,术中在胸骨右旁第四肋间切口3~4cm,切开心包并悬吊,缝双荷包并切开,将输送导管插入右心腔内,通过缺损口入左心腔,经食管超声心动图全程监测封堵过程,引导封堵器的放置,评价即刻封堵效果。结果 68例先心病中66例成功实施封堵术,其中3例残余少量分流。其余2例房间隔缺损改行体外循环修补术。术后随访,经胸超声心动图均无封堵器明显移位和脱落,未见明显异常分流。结论经食管超声心动图用于经胸微创先心病封堵术,是一种微创、安全、简便的方法,具有很好的推广应用价值。

Objective To explore the curative effect of the minimally invasive thoracic esophageal closure guided by Echocardiography in the treatment of congenital heart disease.Methods In this research group,68 children with simple congenital heart disease underwent echocardiography before operation.Intraoperatively,the incision ranged 3~4cm between sternum right next to the fourth rib was performed,the pericardium was cut and suspensed.Double pouch was formed and cut.Subsequently,the catheter was inserted into the right heart chamber and entered into the left heart through the defect.The entire monitoring block process with transesophageal echocardiography guided the placement of the closure device and the immediate effect was evaluated.Results Of those 68 cases of congenital heart disease,66 cases were successfully closured of which 3cases still had small residual shunting.The remaining 2cases of atrial septum defect were repaired under the extracorporeal circulation.Postoperative follow-up showed that the closure device were not obviously shifted and fallen off as evidenced by echocardiography and,also,obvious abnormal shunt was not found.Conclusion The thoracic esophageal closure guided by Echocardiography is a minimally invasive,safe and simple modality,which is well worth for the application in clinic.