经食管超声心动图和经胸超声心动图在房、室间隔缺损封堵术中的应用价值

Utility of transthoracic echocardiography and transesophageal echocardiography guided occluded operation for atrial septal defect and ventricular septal defect

目的探讨经食管超声心动图(TEE)和经胸超声心动图(TTE)引导Amplatzer封堵器堵闭继发孔型房中隔缺损(ASD)、膜周部室中隔缺损(VSD)的应用价值。方法术前经TEE筛选符合条件的28例继发孔型ASD,2例膜周部VSD患者,测量ASD的位置、大小及其与周围的关系,VSD的大小位置,在TTE引导下,以球囊测量ASD的最大伸展径,DSA下以造影测量VSD的大小,选择适当型号的封堵器,经导管堵闭ASD和VSD。结果术前TEE所测的ASD直径11mm～36mm,术中TTE测得ASD的最大伸展径14mm～38mm,前者均小于后者,选择的封堵器的直径为14mm～40mm,28例中,除1例术中转为外科手术治疗,1例未封堵外,余26例均封堵成功,术后即刻、24h、3个月、6个月TTE随访复查均无残余分流及其他并发症。2例VSD术前TEE测量的直径分别为9mm,15mm,术中造影测得的大小为10mm,15mm,两者高度相关。结论超声引导下经导管置入Am-platzer封堵器治疗ASD,VSD是一种安全、快捷、有效的非手术治疗方法。

Objective To determine the utility of transesophageal echocardiography(TEE)and transthoracic echocardiogtaphy(TTE)guided occluded operation with Amplatzer device for atrial septal defect(ASD)and ventricular septal defect(VSD).Methods The study included 28 patients with ASD and 2 patients with VSD ,who were preoperatively selected.The location,size of ASD and its relation to periphery were TIE guided measured in 28 patients with ASD of subsequent foramen pattern,the maximal cxtended diameter of ASD was measured by using ballon.The location,size of VSD were measured by using digital subtraction angiography (DSA)in 2 patients with VSD of membrane periphery part.All occluded operations of ASD and VSD were performed by using adaptive Amplatzer device.Results Among 28 patients with ASD,preoperative TEE measured diameters of ASD were 11～36 mm but intraoperative TTE measured maximal extended diameters of ASD were 14～40 mm,i.e.anterior value was less than latter value.26 of 28 patients with ASD were successful occlusion and then TTE followed up reexaminations showed that the residual shuntings and complications related to the procedure were not observed at the immediacy,24 h,3 month and 6 month after the operation,except one case was changed into surgical treatment and other one case non-underwent the occluded operation.The occlusion rate was 97 %.Among 2 patients with VSD,preoperative TEE measured diameters of VSD were respectively 9 mm and 15 mm while intraoperative measured diameters of VSD were respectively 10 mm and 15 mm ,there was high correlation between the both.Conclusion Ultrasound guided transcatheter insersion of Amplatzer device is a safy,quick,effective and non surgical means for the treatment of ASD and VSD.