X线与彩超结合对先心病封堵术前后心脏及肺血改变的对照研究

目的：评价经导管置入Amplatzer封堵器治疗先天性心脏病房间隔缺损(ASD)和动脉导管未闭(PDA)的疗效。方法：收集我院近年来实施的ASD和PDA封堵术患资料20例，其中ASD10例，PDA10例。所有病例均在透视及食管超声引导下经皮穿刺股静脉置入Amplatzer封堵器。将患术前的X线、彩超资料作为术前组，术后6个月的X线、彩超资料作为术后组．且对术前组和术后组从心脏大血管各径线、血液分流、各房室内径、压力及肺血等方面进行对照分析，全面评价治疗效果。结果：封堵术后X线检查示所有患心胸比率、心脏表面积、右下肺动脉干宽径、右心房心高比率、右心房宽径(RAI)、肺动脉段基线(P1)、肺动脉主干横径(P2)、肺动脉段突出度(P3)等值均变小．肺血均减少，透视下“肺门舞蹈”征消失。经胸超声心动图(TTE)检查．全部病例均无残余分流及再通，各房室内径缩小．压力降至正常。结论：X线与彩超相结合的方法可以从内到外、从形态到功能分析手术前后心脏状况．尤其可观察肺血的改变．从而可以全面地评价手术疗效。经导管置入Amplatzer封堵器治疗ASD、PDA是一种有效的非手术方法．具有操作简单、安全、技术成功率高及封堵效果好等优点，适合各年龄组ASD及PDA的介入治疗，其临床应用的远期疗效尚需观察。

Evaluation of cardiovascular changes after interventional occlusion of congenital heart disease using radiography combined with echocardiography

Objective:To evaluate the effect of interventional occlusion for atrial septal defect (ASD) and patent ductus arteriosus (PDA) with Amplatzer occluder by X-ray in combination with echocardiography. Mechods:20 patients (10 ASD and 10 PDA) with a mean age of 27.3 years (ranged from 7 to 47 years),were all implanted with Amplatzer occluder under X-ray and echocardiography guidance.The imageological data before and 6 months after treatment were analysed and compared.Results:There were no residual shunts after interventional treatment.The heart size,heart surface area,right inferior pulmonary artery diameter,pulmonary vascularity,RAI,P1,P2 and P3 all decreased and pulmonary hilar dance disappeared.Conclusion:X-ray combined with echocardiography can evaluate the effect of interventional occlusion properly.Interventional treatment with Amplatzer occluder is a appropriate therapeutic choice for ASD and PDA.