经食管超声心动图在引导Amplatzer封堵器堵闭房间隔缺损术中的应用

目的探讨经食管超声心动图(TEE)在引导Amplatzer封堵器堵闭房间隔缺损(ASD)术中的应用及价值。方法30例经胸超声心动图(TTE)及TEE术前确诊为Ⅱ孔ASD的患者，经右心导管在TEE引导下用球囊测量ASD最大伸展径，并以此径再加1～2mm选择相应型号Amplatzer封堵器，在TEE监测下置入ASD处，于术后即刻及24小时观察疗效。结果30例ASD患者(男8例，女22例)在TEE引导下均成功置入封堵器，成功率100%，无并发症。TTE测量ASD直径＝(15.0±4.1)mm及TEE测量直径＝(16.6±4.9)mm，ASD径线与球囊测量直径＝（20.4±6.0)mm结果差别均有显著性(P＝0.0001及P＝0.009)。结论Amplatzer封堵器安全可靠，只有在TEE引导下才能准确放置；TEE在术前病例选择，术中并发症监测，术后即刻疗效观察中是必须的。但在选择封堵器型号时不能以TTE及TEE代替球囊测量。

Application of TEE in theASD Occlusion by Amplatzer Device Through Right Cardiac Catheter

Objective:To observe the role of TEE in guiding the Amplatzer occlusion device during ASD occlusion.Methods：Thirty patients with secondary ASD were defined by TTE and TEE and the largest ASD diameter of each patient was measured with gauge balloon which was introduced through right cardiac catheter with the guidance of TEE.The coresponding occluded diameter size of the Amplatzer device was based on the measured extended diameter with balloon plus 1～2mm,which was set into the hole of ASD under the monitoring of TEE.The effect of operation was surveyed immediately and after 24 hrs by TEE.Results:The Amplatzer occlusion device was inserted successfully in all 30 patients(male 8,female 22).With the direction of TEE,the successful rate was 100% without any complications.The diameter of the defect measured both by TTE(D＝15.0±4.1mm)and TEE(D＝16.6±4，9mm)had significant difference from the value measured by balloon(D＝20.4±6.0mm)(P＝0.0001 and P＝0.009)respectively.Conclusions:Amplatzer occlusion device is safe and reliable.TEE has the important role in easily preoperated patient selection,complication monitoring during surgery and effect observation.The device can only be settled and released under the monitoring of TEE,but its size selection still needs to be based on the results from balloon measurement instead of either TTE or TEE.