经食管超声心动图在室间隔缺损微创封堵术中的应用

目的 探讨经食管超声心动图（TEE）在室间隔缺损（VSD）微创封堵术中的应用价值.方法 TEE引导下为85例患者行VSD微创封堵术.术前行经胸超声检查,确定VSD的位置和形态,测量VSD基底部直径、膜部瘤开口直径及VSD上缘至主动脉右冠瓣的距离,选择合适型号的封堵器封堵,评价即刻封堵效果.结果 83例患者成功封堵,2例失败的患者后经TEE及时发现发生情况,并成功转体外循环行修补术.术后出现残余分流的患者13例,新发轻度三尖瓣关闭不全1例,无新发主动脉瓣关闭不全.随访3～29个月,无封堵器脱落、移位及溶血和Ⅲ度传导阻滞的发生.结论 TEE对选择适合行封堵术的VSD患者,选择封堵器大小,指导封堵器的释放,以及评价疗效方面具有重要的作用.

Application of transesophageal echocardiography in closure of ventricular septal defects during the minimally invasive cardiac surgery

Objective To evaluate the application value of transesophageal echocardiography （TEE） in closure of ventricular septal defects （VSD） during the minimally invasive cardiac surgery. Methods Eighty- five patients with VSD received closure of VSD under TEE guidance. Transthoracic echocardiography was performed to determine the location and shape of VSD before operation, whether there were membrane aneurysm and its texture and the number of openings were displayed, the base size of VSD, the diameter of the membrane aneurysm and the distance from the upper edge of VSD to the right coronary aortic valve were measured, the suitable occluder was selected. The post operative effects were evaluated by TEE. Results The occluded operation of VSD was performed successfully in 83 cases, 2 eases were failed and received surgical closure. Residual shunts were seen in 13 cases. There was minimal tricuspid insufficiency in 1 patient, no aortic insufficiency was found. After followed up for 3 - 29 months, no occluder fall off, displacement, hemolysis and III degree conduction block happened. Conclusion TEE plays an important role in selecting suitable patients and determining the size of the occluder correctly before occlusion operation, guiding release of the occluder in operation and evaluating the effect after operation.