彩色超声心动图评价非对称型封堵器在室间隔缺损封堵术中的应用价值

目的 采用彩色超声心动图评价非对称型封堵器在室间隔缺损（VSD）封堵术中的应用价值。方法 采用彩色超声心动图对58例拟行经导管VSD封堵术的患者，术前取胸骨旁五腔心切面、左心室长轴切面、主动脉短轴切面和心尖四腔心切面行超声扫查，确定VSD部位及周围毗邻关系，并测量VSD边缘距主动脉瓣瓣环的最小距离，测量VSD下缘距三尖瓣隔瓣距离；术后采用彩色超声心动图观察封堵器在心腔内的形状及封堵效果，并随访3～12个月。结果 58例VSD患者选择使用非对称型封堵器，封堵术均获成功，其中嵴下型18例（缺损边缘距主动脉瓣最小距离为0．5mm）、膜部13例、肌部3例、嵴内型3例、隔瓣后型21例（缺损边缘距三尖瓣最小距离为1．5mm）。术后超声显示非对称型封堵器图像清晰，封堵器在心脏内呈现超声图像与体外形态相一致。其中3例囊袋形VSD在放置对称型封堵器后因残余分流多而改用非对称型封堵器，效果良好。术后即刻观察9例存在室间隔少量残余分流，24h后完全消失。57例三尖瓣、主动脉瓣均未出现因封堵引起的明显反流，1例术后出现主动脉瓣反流，瞬时反流量约0．5ml，随访3个月，反流无明显增多。结论 根据VSD部位及形态选择非对称型封堵器能进一步扩大封堵术应用范围及提高其安全性；彩色超声心动图在筛选病例、观察疗效及远期随访中起重要辅助作用。

Color echocardiographic evaluation of transcatheter closure of ventricular septal defects using home-made nitinol asymmetric two-disk device

Objective To evaluate the efficacy and safety of transcatheter closure of ventricular septal defects (VSD) using home-made nitinol asymmetric occluder observed via echocardiography. Methods Transcatheter closure using asymmetric occluders were attempted in 58 patients with VSD diagnosed by echocardiography and left ventriculography. After the procedure, the shape and function of the occluder deployed in VSD were followed-up. Results The asymmetric occluders were successfully deployed in 58 patients with VSD located in subinfracristal (18 cases),membranous (13 cases), submembranous (21 cases),infracristal (3 cases ) and muscular (3 cases). The shortest margin of VSD approached to aortic valve annulus was 0.5 mm and to tricuspid valve annulus was 1.5 mm. There was trivial residual shunt in 9 patients observed by left ventriculography and echocardiography after deployment of the devices. No shunt was found in all patients 24 hours after the procedure. There was evident shunt in 3 patients with saccate VSD using symmetric occluders, then shunt disappeared immediately after replacement with asymmetric occluders. There was mild aortic valve regurgitation appearing in one patient after the procedure, but no more regurgitated flow was found 3 months later. No complication occurred in the other patients. Conclusions Echocardiography plays an important role in case selection and evaluating the effects of transcatheter occlusion using asymmetric occluders.