超声引导下经胸或经皮封堵治疗室间隔缺损的进展

Progress in Transthoracic or Percutaneous Device Closure of Ventricular Septal Defect Guided by Transesophageal Echocardiography

室间隔缺损(Ventricular septal defect, VSD)是一种常见的先天性心脏病,约占全部先天性心脏病的20%~30%。根据解剖学位置,VSD可分为膜周部、双动脉干下型和肌部。近年来,经食道超声心动图(Transesophageal echocardiography, TEE)引导下经皮或经胸封堵治疗VSD被广泛推广应用,因其创伤小、手术时间短、操作简便、成功率高、并发症少等优点,目前已成为国内微创治疗VSD的主要手段。除了TEE引导下经股动脉途径的经皮介入,TEE引导下经胸途径又根据VSD病理解剖特点,分为经右胸、左胸和胸骨下段小切口三种途径。如何根据VSD解剖特点,在TEE引导下选择不同的封堵路径和封堵器,达到更安全、可靠的治疗效果,同时减少手术并发症以及提高手术成功率,正是本文综述的目的。

The ventricular septal defect (VSD) is a prevalent congenital heart disease, accounting for approximately 20%~30% of all cases of congenital heart disease. Based on anatomical location, VSD can be categorized into three types: perimembranous, subarterial, and muscular. In recent years, transesophageal echocardiography (TEE) guided percutaneous or transthoracic small incision closure therapy for VSD has been widely promoted and applied. Due to its advantages of small trauma, short surgical time, simple operation, high success rate, and few complications, it has become a widely used treatment for VSD in China. The purpose of this article is to review how to select different occlusion pathways and devices under TEE guidance based on the anatomical characteristics of VSD, in order to achieve safer and more reliable treatment outcomes, reduce surgical complications, and improve surgical success rates.