心脏彩色多普勒超声心动图监测右胸小切口房缺封堵术与右心导管房缺封堵术对比研究

目的探讨评价右胸小切口房缺封堵术与右心导管房缺封堵术的优缺点。 方法43例房间隔缺损（ASD）患者中，21例行介入手术ASD封堵术，22例行右胸小切口ASD封堵术。介入手术ASD封堵术是在大型数字减影血管造影机（DSA）下进行，经胸超声心动图监测封堵器的位置，观察有无残余分流，是否影响二尖瓣及主动脉瓣的功能。右胸小切口ASD封堵术是在手术室进行，无体外循环，完全由超声心动图监测整个过程。 结果21例行介入手术ASD封堵术者成功19例，22例行右胸小切口ASD封堵术全部封堵成功，其中包括腔静脉型房缺3例。 结论房间隔缺损封堵术有2种方式，一是右胸小切口经超声心动图全过程指导放置封堵器，二是经右心导管在DSA下放置ASD封堵器。两者比较介入疗法放置封堵器对患者创伤小，但对30mm以上大房缺及腔静脉型房缺封堵器放置不易成功。而外科微创手术对这些难治型ASD封堵更有优势。

Color Doppler Echocardiography Guided Thoracic Small Incision vs Transcatheter for ASD Occlusion

Objective To evaluate the virtue and defect of the occlusion of atrial septal defect(ASD) via thoracic right small incision vs right cardiac catheterization.Methods In 43 patents with ASD,interventional occlusion through right cardiac catheterization was done in 21 patients,and color Doppler flow imaging (CDFI) guided thoracic right small incision (TRSI) for ASD occlusion in another 22 patients.The interventional occlusion was under the digital substraction angiography(DSA) monitoring the position of occluders,residual shunt and mitral or aortic function,while occlusion operation was done through TRSI under the guidauce of CDFI without extracorporeal circulation but with the same monitoring effects.Results Nineteen of 21 patients treated with interventional occlusion was successful,while all 22 patients with TRSI operation including ASD of vena cava type were successful.Conclusions Comparing the 2 methods,in our study the interventional method has the virtue of minimal trauma to patients,but may be hardly to be successful for large ASD(>30 mm) and for difficult vena cava type whereas the TSRI method has the priority to be successful in those difficult ASD types.