超声心动图指导Amplatzer封堵器在房间隔缺损封堵中的价值

目的探讨超声心动图指导Amplatzer封堵器在不同大小及不同性质周缘房间隔缺损封堵中的意义。方法53例房间隔缺损患者在经食管和经胸超声心动图检查或联合球囊充盈测量房缺大小后行Amplatzer封堵器封堵。结果20例较硬周缘房缺在超声检测房缺大小(16.8±8.8)mm后直接选择封堵器进行封堵，31例缘较软、摆动的房缺球囊充盈测量房缺伸展径(22.4±6.9)mm后选择封堵器封堵。超声所测房缺大小与所用封堵器大小、球囊实测值及球囊在X线下所测量房缺伸展径值相关良好，分别为r＝0.930(P＜0.01)，r＝0.921(P＜0.001)及r＝0.876(P＜0.001)。剔除软缘房缺，则上述相关性更佳，分别为r＝0.984(P＜0.001),r＝0.959(P＜0.001)及r＝0.948(P＜0.001)。结论对于周缘较硬的房缺，经食管超声心动图可直接指导封堵器大小的选择和封堵。而对于房缺缘较软者，应在球囊充盈情况下测量房缺伸展径后选择封堵器。

Value of Amplatzer Occlusion Device of Atrial Septal Defect Guided by Echocardiography

Objective:To probe into the guiding meaning of echocardiography for occlusion of atrial septal defect(ASD)with different size and edge by use of Amplatzer septal occluder.Methods：Fifty three patients with ASD were occluded by use of Amplatzer Septal occluder after transesophageal and transthoracic echocardiographic detection or measurement of expanding size of ASD with balloon filling.Results:Twenty cases of ASD(16.8±8.8mm)with solid edge were occluded with selected Amplatzer septal occluder depending on echocardiographic examination.Thirty one patients with soft and flappy edge ASD(22.4±6.9mm)were closed by use of the Amplatzer septal occluder,which sizes were decided according to ASD expanding size by balloon.Correlation between the echo size of ASD and Occluder size,real measurement of balloon and balloon size measured in X ray were fine,r＝0.930(P＜0.01),r＝0.921(P＜0.001)and r＝0.876(P＜0.001)respectively.After eliminating ASD with soft and flappy edge,the correlation became excellent,r＝0.984(P＜0.001),r＝0.959(P＜0.001)and r＝0.948(P＜0.001)respectively.Conclusions:Echocardiography can be used for guidance of Amplatzer occlusion device of ASD with solid edge without the measurement of balloon expanding size of ASD.However,the expanding size should be measured in ASD with soft and flappy edge.