经食道超声心动图在成人继发孔ASD封堵治疗中的应用价值

目的：探讨经食道超声心动图（TEE）在成人继发孔房间隔缺损（ASD）介入及外科微创封堵术治疗中的应用价值。方法：以2012年1月至12月间通过经胸壁超声心动图（TTE）及 TEE 筛选的行介入封堵（91例）及外科微创封堵（43例）治疗的134例成人（＞15岁）单纯继发孔 ASD 患者为研究对象，介入组患者术中行 TTE 监护，外科微创组患者术中行 TEE 监护。对术前 TTE 和 TEE 相关参数及手术结果进行对照分析。结果：两组患者ASD 缺损径的 TEE 测值均显著大于 TTE 测值（P 均＜0.01），最大缺损径的 TEE 测值均显著大于 TTE 测值（19.8±5.2）mm 比（18.7±4.9）mm]，P ＜0.01；最大缺损径的 TTE 测值与封堵器大小间相关性（介入组 r＝0.926，外科微创组 r＝0.215）均低于 TEE （介入组 r＝0.965，外科微创组 r＝0.627），P 均＜0.01。结论：经食道超声心动图对房间隔缺损的大小评估优于经胸壁超声心动图，应作为成人房间隔缺损封堵患者术前筛查的常规检查，在外科微创封堵房间隔缺损中作为实时监测引导、即刻评价疗效具有重要价值。

Application value of TEE on occlusion of secondum atrial septal defect in adult patients

Objective：To explore the application value of transesophageal echocardiography （TEE）in secondum atri-al septal defect （ASD）intervention and minimally invasive occlusion surgery in adult patients.Methods：A total of 134 cases adult patients （〉15 years）with pure secondum ASD （including 91 cases undergoing interventional occlu-sion and 43 cases undergoing minimally invasive occlusion surgery）,who were screened via transthoracic echocardio-graphy （TTE）and TEE from Jan 2012 to Dec 2012,were selected.Intervention group and minimally invasive sur-gery group received TTE and TEE monitoring respectively during operation.Preoperative TTE and TEE parameters and operation results were compared and analyzed.Results：The parameters of ASD diameter measured by TEE were significantly higher than those measured by TTE in two groups （P 〈0.01 all）.Maximum defect diameter of ASD measured by TEE was significantly higher than that of measured by TTE （19.8±5.2）mm vs.（18.7±4.9）mm], P 〈0.01. The correlation between maximum defect diameter measured by TTE and occluder size （intervention group r =0.926,minimally invasive surgery group r =0.215）was all lower than that of TEE （intervention group r=0.965,minimally invasive surgery group r =0.627）,P 〈0.01 both.Conclusion：TEE is better than TTE in as-sessment of ASD size.It should be regarded as a routine preoperative screening method for adult ASD patients.It has important value in real-time monitoring,guidance and immediate evaluation of therapeutic effects during mini-mally invasive ASD occlusion surgery.