超声心动图在应用Amplatzer封堵器关闭儿童房间隔缺损中的应用价值

目的　评价经胸超声心动图 (TTE)和经食管超声心动图 (TEE)在应用Amplatzer封堵器关闭儿童房间隔缺损(ASD)中的应用价值。方法　对 12例拟诊为继发孔型ASD的儿童 (年龄 2～ 13岁 ) ,应用Amplatzer封堵器经导管关闭ASD。通过TTE和 (或 )TEE在术前显示ASD大小及其边缘的解剖特点 ,术中指导封堵器的放置 ,术后评价疗效。结果　 (1) 12例中 ,TEE排除ASD诊断 1例 ,诊断为下腔型ASD和显示缺损前上缘薄弱者各 1例 ,这 3例未实施封堵术。 (2 )TEE测量ASD大小 (5～ 2 6mm ,平均 13 6mm) ,与ASD伸展径 (7～ 30mm ,平均 16 6mm)具有高度相关性 (r=0 994 ,P <0 0 1) ;与术前TTE测量ASD大小很接近 (5～ 2 1mm ,平均 14 3mm) ,后者与ASD伸展径亦具有高度相关性 (r =0 932 ,P <0 0 1)。 (3) 9例实施封堵术者 ,有 8例封堵成功 ;1例在封堵器释放后 15min发生脱落 ,改为外科修补。 (4) 8例成功实施封堵术者经TTE随访 1～ 2 2个月 ,无残余分流征象。结论　应用Amplatzer封堵器经导管关闭ASD可取得良好效果 ;超声心动图在经导管关闭ASD过程中具有重要价值 ,TTE和TEE各具优点 ,TTE适用于病例的初步筛选和术后随访 ;而TEE则在决定是否进行封堵术和指导封堵器的正确放置等方面发挥重要的作用。

Value of echocardiography in transcatheter closure of atrial septal defects using Amplatzer septal occluder

Objective To study the values of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in transcatheter closure of atrial septal defects (ASD) by using Amplatzer septal occluder. Methods Twelve patients aged 2-13 years underwent echocardiography during attempted ASD closure with the Amplatzer device.TTE and TEE were performed to examine the ASDs and the rims before catheterization to evaluate the placement of the occluder device and the efficacy.Results Out of 12 patients,transcatheter closure was aborted in three cases because of TEE findings,in which one had no ASD,one had little inferior-posterior rim,and the last had large defect with extremely weak superior-anterior rim.The sizes of ASDs measured with TTE were 5-21mm (13.6mm in average) which were well correlated with the extended diameters (7-30mm,16.6mm in average) of defects (r=0.994,P<0.01),and those measured with TEE were 5-26mm (14.3mm in average)which also had good correlation with the extended diameter ( r=0.932,P<0.01).The transcatheter closure was performed in the other 9 patients. The Amplatzer devices were successfully implanted in 8 patients. However,the occlusion failed in one case in whom the device detached from the inferior-posterior rim 15min after release of the device.TTE revealed no residual shunts in 8cases with the successful implantation at 1-22-month follow-up.Conclusion TTE and TEE both play crucial role in the safety and efficacy assessment of the procedure. TTE is a useful approach for the preliminary selection of appropriate ASDs and for result evaluation at follow-up. TEE provides indispensable information and enables precise determination of device size,correct placement of the device and immediate assessment of the closure procedure.