经胸实时三维超声心动图独立指导房间隔缺损封堵术21例

目的:评价经胸实时三维超声心动图（RT-3DE）在对房间隔缺损（ASD）诊断和指导封堵器选择以及对封堵术进程独立引导的价值。方法:21例ASD患者术前经二维及RT-3DE诊断明确，用三维成像显示缺损全景，了解缺损形态并测量缺损面积。术中与X线同步进行全程引导，术后评价封堵效果。测得封堵器腰部展开最大径同三维超声测得缺损面积并做相关性研究。结果:所有手术均顺利完成。经胸实时RT-3DE能显示缺损的形态、大小、位置和封堵器释放形态。通过三维超声测得ASD面积与封堵器腰部展开最大直径减2 mm作为直径求得的圆面积差异无统计学意义（P > 0.05）。超声同X线图像对鞘管、封堵伞所处位置和封堵伞释放状态的判断差异均无统计学意义（P > 0.05）。结论:经胸RT-3DE单独作为指导封堵术的影像学手段是可行的，能避免X线辐射，有应用价值。

Application of the transcatheter closure in atrial septal defect guided by real-time three-dimensional echocardiography in 21 cases

Objective: To evaluate the value of the real-time three-dimensional echocardiograph(RT-3DE) in the diagnosis of atrial septal defect(ASD) and guidance of transcatheter closure.Methods: Twenty-one patients with ASD were diagnosed by two-dimensional ultrasound and RT-3DE,the defect panorama was showed by three-dimensional imaging,the area of which was measured.The whole process of operation were guided by RT-3DE and fluoroscopy,and the blockage effects were evaluated after operation.The correlation between the maximum diameter of waist occluder and defect area measured by RT-3DE were studied.Results: All operations were successfully completed.Transthoracic RT-3DE could clearly display the shape,size,position of ASD and occluder releasing process.The differences of the ASD areas between RT-3DE measuring and maximum diameter of the waist minus 2 mm calculating were not statistically significant(P > 0.05).This differences between RT-3DE and X-ray in identifying the position and status of sheath,and occluder releasing were not statistically significant(P > 0.05).Conclusions: The method of transthoracic RT-3DE in guiding the closure of ASD is feasible,which can avoid the radiation of X-ray and has application value.