超声心动图在外科微创封堵治疗继发孔型房间隔缺损中的应用

目的探讨超声心动图在外科微创封堵治疗房间隔缺损（ASD）中的应用价值。方法术前经胸超声心动图（TTE）筛选单纯继发孔中央型ASD 20例,术中经食管超声心动图（TEE）进一步评估引导外科微创封堵治疗,术后7 d、3-6月TTE随访。结果 20例患者行ASD外科微创封堵术,封堵成功20例,占100%。TEE与TTE对ASD最大径测量值差异无统计学意义（P〉0.05）。术后7 d、3-6个月TTE随访,封堵器位置固定,未见移位,对周围瓣膜功能及静脉回流无影响,2例有微量残余分流;右心重构改善,右房、右室大小较术前缩小,肺动脉血流速度降低。结论超声心动图参与了外科微创封堵治疗ASD的全过程,TEE与TTE联合应用,对术前诊断与筛选、术中选择封堵器和实时监控、术后效果评价具有不可或缺的重要作用。

Application of echocardiography in minimally invasive surgical closure of secondary atrial septal defect

Objective To assess the application value of echocardiography in minimally invasive surgical closure of secondary atrial septal defect（ASD）. Methods Twenty patients with isolated secundum central ASD were included based on preoperative TTE results,and received minimally invasive surgical closure under simultaneous assessment and guidance of intraoperative TEE. All patients were followed up for severn days,3 to 6 months using TTE. Results TEE guided minimally invasive surgical closure was successful in twenty patients（100%）. The maximum diameter of ASD measured by TEE and TTE were no significantly different（P〉0. 05）. During severn days,3 to 6 months follow-up,occluder was well fixed and didn＇t affect the function of atrial-ventricular valves and venous return,two patients were found with trace residual shunt. The remodeling of right atrium and right ventricle was reversed with decreased dimension,and the pulmonary artery flow velocity was significantly reduced after surgery. Conclusion In our study,echocardiography was performed through out the course of minimally invasive surgical closure of ASD. Combined application of TEE and TTE was effective in providing preoperative diagnosis and screening for eligible patients,intraoperative guidance for the selection of appropriate occluder and real-time monitoring,as well as evaluation during postoperative follow-up.