超声心动图在外科微创封堵治疗室间隔缺损中的应用

目的 探讨超声心动图在外科微创封堵治疗室间隔缺损中的应用价值.方法 73例室间隔缺损病人,合并膜部瘤形成35例,其中21例膜部瘤合并多处破口.所有病例采用胸骨旁小切口,置入等边封堵器闭合VSD.术中TEE监测封堵过程,引导封堵器的放置,术后即刻评价疗效.术后1年采用经胸超声心动图(TTE)跟踪随访.结果 73例在超声心动图监测引导下置入封堵器均获成功,术中即刻用经食管超声检查显示,9例封堵器边缘仍存在微量至少量残余分流;术后48 h复查显示7例仍存在微量分流.术后1年随访中4例仍有微量残余分流,但显示左心室内径、容积较术前明显减小,基本恢复正常水平,肺动脉收缩压较术前明显减低.结论 超声心动图在外科微创治封堵疗的室间隔缺损中,对术前适应证的筛选、术中实时监测及术后疗效评定方面具有重要作用.

Abstract：

Objective To assess the application of echocardiography in mini-invasive surgical device closure of ventricular septal defect (VSD). Methods 73 VSD patients including 35 with aneurysm formation and among them 21 with multi-defects in the aneurysm were treated by mini-invasive device closure. A closure device was positioned to the defect through parastemal mini-incision in all patients. TEE was used to monitor the whole procedure, to guide the device positioning and to evaluate the curative effect instantly after operation. All patients were evaluated by TTE one year postoperatively. Results All patients were successfully positioned closure devices by TEE guiding. 9 cases were found with trace to small amount residual shunt instantly after operation. 7 cases still had small amount residual shunt at the time of 48 hours after the operation. In the one year follow-up, 4 cases had residual shunt, but the size and volume of left ventricle were significantly reduced than those before operation, and the pulmonary artery systolic pressure was also reduced. Conclusion Echocardiography possesses an important role in preoperative indication screening, intraoperation monitoring and evaluating the curative effect postoperatively.

The role of echocardiography in min-invasive surgical device closure of ventricular septal defect

Objective To assess the application of echocardiography in mini-invasive surgical device closure of ventricular septal defect (VSD). Methods 73 VSD patients including 35 with aneurysm formation and among them 21 with multi-defects in the aneurysm were treated by mini-invasive device closure. A closure device was positioned to the defect through parastemal mini-incision in all patients. TEE was used to monitor the whole procedure, to guide the device positioning and to evaluate the curative effect instantly after operation. All patients were evaluated by TTE one year postoperatively. Results All patients were successfully positioned closure devices by TEE guiding. 9 cases were found with trace to small amount residual shunt instantly after operation. 7 cases still had small amount residual shunt at the time of 48 hours after the operation. In the one year follow-up, 4 cases had residual shunt, but the size and volume of left ventricle were significantly reduced than those before operation, and the pulmonary artery systolic pressure was also reduced. Conclusion Echocardiography possesses an important role in preoperative indication screening, intraoperation monitoring and evaluating the curative effect postoperatively.