摘要
目的探讨经食管超声心动图(TEE)在引导经胸微创封堵术治疗中央型房间隔缺损(ASD)中的应用价值。方法选取单纯ASD患者83例,所有患者均应用经胸超声心动图筛选适宜行经胸微创封堵术。术中先应用TEE测量ASD最大直径和房间隔长度,观察ASD形态及其与上下腔静脉的关系,确定合适的Amplatzer ASD封堵器号数,再经TEE引导下监测封堵,即刻观察手术效果。术后24 h和出院前经胸超声复查确定疗效。结果83例患者ASD最大直径4~26 mm,平均(16.76±1.21)mm;ASD最大直径与封堵器大小相关性良好(r=0.936,P<0.01)。TEE引导房间隔穿刺、输送鞘管放置及封堵器输送释放,83例患者中除4例封堵失败改为体外循环下外科手术治疗外,余79例均成功完成经胸微创封堵术,手术成功率95.18%。出院前经胸超声复查仅1例有少量残余分流。结论 TEE能准确评估ASD形态及大小并选择合适封堵器,引导房间隔穿刺、封堵器输送及成功释放,即刻评价封堵器位置和残余分流,该手术方法创伤小、无辐射,临床应用价值高。
Objective To investigate the application value of transesophageal echocardiography（TEE）in transthoracic minimally invasive closure of atrial septal defects（ASD）.Methods Eighty-three patients diagnosed as ASD were selected and adaptive for transthoracic closure assessed by transthoracic echocardiography.During operation,the shape and maximum diameter of ASD,the length of the atrial septal,and the relationship between the ASD and the superior or inferior caval vein were measured carefully by TEE.Then,the most appropriate type of Amplatzer ASD closure was determined.The all process of closure of ASD was under guidance of TEE.The immediate effect after release of ASD closure was evaluated by TEE.The effects 24 h after operation and before discharge were evaluated by TTE.Results Diameter of ASD was 4~26 mm and average diameter of ASD was（16.76±1.21）mm.The correlation between the maximum diameter of ASD and the size of ASD closure was good（r=0.936,P0.01）.Paracentesis of interatrial septum,placement of the sheaths and delivery of the closure were guided by TEE.ASD was succefully closed in 79 cases（achievement ratio of operation was 95.18%）.The other 4 cases were converted to ASD repair by extracorporeal circulation.Before discharge,residual shunt was found in only 1 case.Conclusion TEE can precisely assess the shape and maximum diameter of ASD,help to choose the most appropriate type of ASD closure,guide the process of transport and release the ASD closure,and evaluate the effect of ASD closure.This method is minimally invasive and without radiation injury,and has a high clinical value.
出处
《临床超声医学杂志》
2018年第1期9-11,共3页
Journal of Clinical Ultrasound in Medicine
基金
国家自然科学基金项目(81500298)
广州市"珠江科技新星"基金项目(201610010094)
关键词
超声心动描记术
经食管
房间隔缺损
经胸微创封堵术
Echocardiography, transesophageal
Atrial septal defect
Transthoracic minimally invasive closure
