超声心动图在膜周部室缺封堵术中应用价值

Value of echocardiography in transcatheter closure of perimembranous ventricular septal defects

目的 探讨超声心动图 (Echo)在膜周部室间隔缺损 (VSD)封堵中的应用价值。方法 2 3例VSD。术前Echo明确VSD大小及距主动脉瓣距离 (VSD AV ) ,术中Echo引导监护 ,术后Echo随访。结果 X线造影与Echo测量VSD大小相符 (P >0 .0 5 ) ;VSD AV在无膜部膨出瘤者两种方法检测相符 (P >0 .0 5 ) ,在有膜部膨出瘤者有差异 (P≤ 0 .0 5 )。总计19例即刻封堵成功 ,其中 1例术后出现主动脉瓣和三尖瓣轻 中度返流外科手术取出封堵器并修补VSD ,余 18例短中期随访未见并发症。 2 3例VSD中 5例未完成封堵者具体原因与Echo应用无直接关系。结论 Echo在VSD封堵术前病例选择、术中引导和监护、术后随访等方面均具有重要作用。

Objective To discuss the experience and value of echocardiography in transcatheter closure of perimembranous ventricular septal defects (VSD). Methods The study included 23 cases of VSD. Before operation transthoracic echocardiography (TTE) was performed to confirm VSD size and the distance of VSD to aortic valve (VSD AV). During operation echocardiography (TEE or TTE) was used for guiding and monitoring the whole process of transcatheter closure of VSD. After operation TTE was used for follow up. Results The result of VSD size was accorded between angiogram and TEE ( P >0.05);The VSD AV was accorded between angiogram and TTE ( P >0.05) in cases with VSD there was no perimembranous pseudoaneurysm.But in the cases with perimembranous pseudoaneurysm the VSD AV was not accorded between angiogram and TTE ( P <0.05). Total transcatheter deployment of the device was successful in 19 patients immediately. One of 19 cases appeared small to middle tricuspid and aortic valve regurgitation and performed cardiac surgical operation after VSD closure. There was no complication in other 18 cases during short to middle period follow up. There were 5 cases failed for VSD closure in the study. The cause of failure was not directly related to echocardiography. Conclusion Echocardiography plays a very important role in selecting candidates before operation, guiding and monitoring during operation, following up after operation.