超声心动图在室间隔膜周部缺损经导管封堵术中筛选病例的作用

目的　探讨超声心动图为经导管封堵术筛选室间隔膜周部缺损 (VSD)病例的作用。方法2 6例室间隔膜周部缺损患者实施经导管封堵术。封堵器为国产镍钛合金制成的双盘片结构封堵器。经胸壁超声心动图获取图像。结果　 2 4例成功放置封堵器。VSD的大小平均为 6.4mm ,最大为 10mm ,最小为 4mm。放置封堵器的型号较相应VSD大 2mm ,最大为 12mm。VSD具体分型包括单纯膜部 5例 ,嵴下型 6例 ,隔瓣后型 13例 ,其中嵴下型缺损上缘距主动脉瓣环下缘最小距离为 2mm ;隔瓣后型缺损下缘距三尖瓣隔瓣最小距离为 3mm。单纯膜部缺损易于封堵。 2 1例患者封堵术后即刻观察 ,穿隔血流消失 ,术后 1周超声复查 ,封堵器位置良好、稳定、无残余分流。 3例隔瓣后VSD在封堵术后即刻存在少量分流。术后 1月超声复查 ,封堵器位置良好、稳定 ,1例残余分流消失 ,2例残余分流减少。 2例VSD封堵术中因为引起主动脉反流而放弃封堵。结论　超声心动图选择合适的病例是保证VSD封堵术成功的前提

Role of echocardiography in case selection in transcatheter closure of perimembranous ventricular septal defect using occluder

Objective To study the role of echocardiography in case selection in transcatheter closure of perimembranous ventricular septal defect (VSD) with occluder.Methods Transcatheter closure was conducted on 26 patients with perimembranous VSD. Occluders were made of China. The images were acquired with transthoracic echocardiography. Results Twenty four patients were implanted with occluders successfully. The VSD diameter by echocardiography was 4-10 mm, average was 6.4 mm.The implanted occluder device was 2 mm larger than VSD,the maximal one was 12 mm. Perimembranous VSDs were classified by subinfracristal ( 5 cases ),membranous(6 cases), submembranous (13 cases),and the minimum distance between VSD and aortic valve annulus was 2 mm,between VSD and tricuspid valve was 3 mm. Membranous VSD was easy to be occluded. Echocardiography immediately after placement showed no residual shunt in 21 patients. The one week follow up examination showed complete closures in 21 patients. Echocardiography immediately after placement showed mild residual shunts in 3 VSD, the residual shunt disappeared after one month in one patient, two patients had mild shunt. Two VSD abandoned the occlusion because of aortic valve regurgitation increasing. Conclusions Echocardiography plays an important role in case selection.