经食管实时三维超声心动图在经胸微创继发孔型房间隔缺损封堵术中的应用

目的探讨经食管实时三维超声心动图（RT-3D-TEE）在经胸微创封堵术治疗继发孔型房间隔缺损（SASD）中的应用价值。方法对TTE诊断为SASD的58例患者行经胸微创封堵治疗。术前行RT-3D-TEE检查,明确SASD的位置、类型、大小及边缘情况,以选择合适的封堵器;术中于RT-3D-TEE引导下放置封堵器;术后即刻评价封堵效果,1周后复查TTE。结果58例患者均封堵成功,3例少量残余分流;术后1周TTE检查示封堵器位置正常,均无残余分流。结论RT-3I）_TEE可立体显示SASD的部位、形态及与周围结构的空间关系,对于选择封堵器型号、全方位引导放置封堵器及术后疗效评价具有重要临床应用价值。     

实时三维经食管超声心动图在成人房间隔缺损介入封堵术中的应用

目的探讨实时三维TEE(RT-3D-TEE)在成人房间隔缺损(ASD)经导管封堵术中的应用价值。方法对TTE初筛后拟行封堵治疗的31例ASD患者行RT-3D-TEE检查,测量缺损最大径和面积,与TTE、二维TEE(2D-TEE)测值进行比较;评价缺损解剖特征,判断其是否适宜行封堵术,并选择封堵器型号。结果 TTE、2D-TEE和RT-3D-TEE测量ASD最大径分别为(21.32±6.21)mm、(22.80±5.87)mm和(23.44±5.90)mm,RT-3D-TEE与TTE和2D-TEE比较差异均无统计学意义(P均>0.05);RT-3D-TEE所测缺损面积与最大径显著相关(r=0.92,P<0.05);RT-3D-TEE显示房间隔缺损形状多为近似椭圆形,较少为不规则形及近似圆形,可清晰显示ASD残缘情况及周围毗邻结构的空间关系;根据RT-3D-TEE结果,29例属封堵术适应证,并封堵成功,封堵器大小为最大径测值+(5.4±2.3)mm。结论 RT-3D-TEE可直观评价ASD大小、形态及毗邻结构空间关系,在成人ASD封堵治疗中有重要应用价值。     

实时三维经食管超声心动图在房间隔缺损诊断及介入治疗中的应用进展

经导管房间隔缺损介入封堵术（TCASD）在治疗房间隔缺损（ASD）中已具有较高的成功率,筛选适应证和准确安置封堵器对手术成功至关重要。新近研发的实时三维经食管超声心动图（RT3D-TEE）技术可获取高质量的三维图像,并可直视缺损,精确测量缺损内径和面积,更好地评价缺损残缘及与周围结构的关系;实时、全程监护TCASD,纠正封堵器植入处残余分流、降低术后并发症。RT3D-TEE是评价ASD及指导介入治疗的新选择、新参考。本文对RT3D-TEE在诊断及介入治疗ASD中的应用进展进行综述。     

立体三维超声心动图在房间隔缺损介入封堵术监测中的应用

目的探讨立体三维超声心动图在房间隔缺损介入封堵术监测中的应用价值。方法应用立体三维超声心动图对6例行房间隔缺损介入封堵术的患者行全程术中监测,成像模式包括＂4DRealTime＂和＂FullVolume＂。结果立体三维超声心动图能直观显示心内鞘管的位置及走行,逼真显示封堵器展开、释放过程及释放后与周围组织的位置关系,对引导封堵器和改进封堵效果有很大帮助。结论立体三维超声心动图较传统二维及实时三维方法能更清晰、直观显示封堵过程,具有良好的临床应用价值及广阔的应用前景。     

Supplementing transesophageal echocardiography with transthoracic echocardiography for monitoring transcatheter closure of atrial septal defects with attenuated anterior rim: a case series

The use of transesophageal echocardiography (TEE) for guidance of transcatheter closure of secundum-type atrial septal defect (ASD) is increasingly becoming a routine procedure. ASD with attenuated anterior superior (SA) rim is a variant of secundum-type ASD and is suitable for transcatheter closure. The success rate of TEE guidance for device deployment in these patients is not known. Therefore, we assessed 124 consecutive patients with ASD (57 secundum-type, 67 with attenuated SA rim) closed with an Amplatzer Septal Occluder under TEE guidance. Our results show that the TEE was successful in depicting all 4 corners and corresponding edges of each Amplatzer disk, as well as the septal rims of all 57 secundum-type ASDs. However, in 6 of 67 ASDs (9%) with attenuated SA rim in which TEE failed to visualize the adequate placement of occluder on the anterior inferior (IA) rim, the additional use of transthoracic echocardiography helped to resolve this inadequacy. Four of these six patients had the unusual morphology of the IA rim tissue. Two had severe right axis deviation of the heart with large Q angle (>90 degrees ). The SA rim was absent in 35 of 67 ASDs with attenuated SA rim and in these cases TEE demonstrated the anterior surface of the disk against the wall of the aorta but without distortion. We conclude that TEE can be useful for confirming successful deployment of the occluder in most patients with ASDs. In a small number of ASDs with attenuated SA rim who have unusual IA morphology, supplemental transthoracic echocardiography is required to verify successful deployment of the occluder when TEE visualization fails to reliably diagnose adequate placement of the occluder. IMPLICATIONS: Transesophageal echocardiography can be useful for confirming successful deployment of the occluder in the majority of patients with atrial septal defect. In a small number of atrial septal defects with attenuated anterior superior rim which have unusual anterior inferior morphology, supplemental transthoracic echocardiography is required to verify successful deployment of the occluder when transesophageal echocardiography visualization fails to reliably diagnose adequate placement of the occluder.     

Three-dimensional transesophageal echocardiography in the diagnosis of atrial septal aneurysm with patent foramen ovale in a patient with ventricular septal defect

We present a case of a rare combination of ventricular septal defect and atrial septal aneurysm (ASA) with a patent foramen ovale (PFO) in a 57-year-old female. She was referred to our hospital for the treatment of irregular palpitation and exertional shortness of breath. Two-dimensional transesophageal echocardiography (2D-TEE) with color Doppler imaging demonstrated an ASA with two lines of shunt flows. Three-dimensional transesophageal echocardiography (3D-TEE) could clearly visualize the morphology of the PFO in the surgeon??s view and demonstrated a crescent-shaped opening of the PFO. 3D-TEE appears to be a more accurate modality than 2D-TEE for the assessment of PFO.     

超声心动图在经导管房间隔缺损封堵术中的应用

经导管介入封堵术是治疗房间隔缺损(atrial septal defect,ASD)的重要方法。超声心动图不仅能指导选择封堵器型号,而且可在术前筛查、术中监测及术后复查中发挥重要作用。本研究探讨超声心动图在ASD经导管封堵治疗过程中的应用价值。1资料与方法1.1研究对象2011年10月—     

Tornado-like appearance of spontaneous echo contrast assessed by real-time 3D transesophageal echocardiography

We report a case showing that real-time 3D transesophageal echocardiography provides unique information about the dynamic nature of spontaneous echo contrast (SEC) in 3D space and has the potential to provide better understanding of SEC. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

经食管超声心动图监测微创室间隔缺损封堵术

目的探讨TEE在监测探条辅助微创室间隔缺损（VSD）封堵术中的临床价值。方法 100例VSD患者术前均接受TTE检查,以明确VSD的位置、类型、大小及边缘情况,来选择合适的封堵器。在TEE引导下选择荷包开口位置,实时监测封堵器放置并即刻评价手术疗效。术后1周内行TTE复查。结果 100例患者全部封堵成功,实心探条输送法55例,中空探条输送法33例,直接输送法12例。患者均于术后3～4天出院,随访1～12个月,无封堵器脱落、移位、溶血和房室传导阻滞等并发症发生。结论 TEE在探条辅助经胸微创封堵VSD的术中引导和术后评价中均发挥重要作用,使该术成为更简便可行、成功率更高的封堵方法。     

Successful repair of a traumatic ventricular septal defect using an amplatzer occluder guided by three-dimensional transesophageal echocardiography

Transesophageal echocardiogram (TEE) guided perventricular cardiac intervention has gained popularity in recent years. We present a special case of perventricular closure conducted for a traumatic apical muscular ventricular septal defect (mVSD) under the guidance of three-dimensional (3D) TEE with an Amplatzer mVSD occluder and further discuss the important role of 3D TEE in perventricular cardiac intervention.     

超声心动图在经胸微创房间隔缺损封堵术中的应用

【摘要】〓目的〓探讨超声心动图在经胸微创房间隔缺损(ASD)封堵术中的临床应用价值。方法〓在本院2013年7月至2014年12月经胸超声心动图(TTE)诊断的房间隔缺损患者43例中,筛选适合进行经胸微创房间隔缺损封堵术病例31例,术中采用经食道超声心动图(TEE)监测引导封堵过程,术后采用TTE随访评价疗效。结果〓31例ASD患者在TEE引导下行经胸微创封堵治疗,全部封堵成功,术后无并发症。随访3个月仅1例出现3 mm残余分流。结论〓超声心动图对经胸微创ASD封堵术的术前病例筛选、术中监测引导和术后疗效评价具有重要作用。     

TEE在非瓣膜性心房颤动患者主动脉内-中膜厚度检查中的应用

目的应用TEE测量非瓣膜性心房颤动患者的主动脉内-中膜厚度（aIMT）,并观察斑块大小及性质。方法对87例非瓣膜性心房颤动患者行TEE检查,在降主动脉前壁测量aIMT,观察其与患者性别、年龄及高血压等并发症的关系。结果多元线性回归分析显示aIMT与年龄及血压有明显相关性,而与性别无相关。合并高血压患者aIMT较未合并高血压者明显增厚,分别为（O．88±0．40）mm、（O．83±0．44）mm（P＜O．05）;男性及女性患者的aIMT分别为（0．88＋0．04）mm、（O．86士0．05）mm（P＜0．05）。在14例患者中发现17处粥样硬化斑块,均为Ⅲ级斑块,斑块大小为（3．83土0．16）mmX（3．99士0．15）mm。结论非瓣膜性心房颤动患者aIMT的变化与高血压密切相关,同时年龄亦是aIMT的重要影响因素;未发现性别对aIMT的影响。