经食管超声心动图在婴幼儿多发性房间隔缺损经胸微创封堵术中的应用

目的 探讨经食管超声心动图在婴幼儿多发性房间隔缺损（ASD）经胸微创封堵术中的应用价值。方法 18例多发性ASD患儿，经右侧胸骨旁微创小切口显露右心房。在术中食管超声心动图（TEE）指引下，测量ASD的大小及数目、孔间距，并据此选择合适类型的房间隔缺损封堵器。TEE引导封堵器的套管经房间隔缺损进入左房并对多发性ASD进行封堵，术后即刻评价封堵器治疗多发性房间隔缺损的效果。结果 18例患者均采用1个封堵器封堵多发性ASD成功。术后即刻TEE检查所有患儿封堵器位置良好，封堵器无变形、移位和脱落，多发性ASD无残余分流，心脏瓣膜功能不受影响。结论 经胸微创封堵术治疗婴幼儿多发性ASD是安全、有效的技术，TEE对病例和封堵器的选择及术中引导和监测、术后随访均具有重要的临床意义。

Application of trans-esophageal echocardiography in trans-thoracic minimal invasive occlusion surgery of infantile multiple atrial septal defect

Objective To explore the application value of the trans-esophageal echocardiography （TEE） for the trans-thoracic minimal invasive occlusionsurgery of infantile multiple atrial septal defect （ASD）. Methods The right atrium of 18 patients with multiple ASD was exposed by minimal invasive incisionbesides the right sternum. The size and number of ASD and the distance between ASD were measured by the guidance of TEE. According to the measurements,proper ASD occluders were selected. The sleeve of occluder went through atrial septal defect, entered the left atrium, and occluded the multiple ASD by theguidance of TEE. The results of treating the multiple ASD by the occluder were evaluated immediately after the operation. Results Multiple ASD of 18 patientswere all occluded by one occluder for each patient. Immediate TEE examination after operation showed that all occluders were in good positions withoutdeformations, movements, and shedding. Multiple ASD had no residual shunt. Functions of cardiac valves were not affected. Conclusion The treatment of infantilemultiple ASD by the trans-thoracic minimal invasive occlusion surgery is a safe and effective technology. TEE is clinically very important for selectingcases and occluders, intra-operative guidance and observations, and follow-up.