经胸超声在Amplatzer封堵器介入治疗先天性房室间隔缺损中的临床应用

目的探讨经胸超声在AmpLatzer封堵器介入治疗先天性房间隔缺损、室间隔缺损中的临床应用价值。方法术前应用经胸超声筛选封堵术适应证36例先心病,其中26例房间隔缺损、10例室间隔缺损。术中用经胸超声监测指导释放封堵器,即刻观察疗效。于胸骨旁四腔观、房间隔短轴观、心尖四腔观、心尖五腔观、大动脉短轴观、剑突下四腔心观分别观察封堵器的形态,瓣膜反流及封堵器周围分流情况。术后进行定期复查。结果26例房间隔缺损、10例室间隔缺损封堵成功,总成功率100%。其中16例出现二、三尖瓣反流或残余分流,经调整封堵器的位置和方向后,10例反流即刻消失,6例术后1个月消失。结论经胸超声可用来筛选房间隔缺损、室间隔缺损封堵术病例,术中指导Amplatzer封堵器定位和释放,疗效评估和预后评价方面有不可替代的临床应用价值。

Clinical significance of transthoracic echocardiography in interventional treatment of secundum atrial septal defect and ventricular septal defect

Objective To study the clinical significance of transthoracic echocardiography(TTE) in the interventional treatment of secundum atrial septal defect(ASD) and ventricular septal defect(VSD) with Amplatzer occluders.Methods TTE study was performed before the interventional therapy to select cases with the indication including twenty-six cases with ASD and ten cases with VSD.The defect closures were monitored and guided with TTE throughout the procedure.The configuration of occluder,the instance of valve counter current and shunt around the occluder were observed at parasternal four cavities crosssection,cardiac apex four cavities crossection,cardiac apex five cavities,aorta minor axis crossection and xiphoid process crossection.In sixteen cases,mitral valve,tricuspid valve had shunt or small shunt.After regulating the position and direction of the occluder,10 cases shunt disappeared and 6 cases disappeared after the operation.Results The occlusions of twenty-six cases with ASD and ten cases with VSD were successful and the rate of success was 100%.Conclusions TTE is a useful approach to the preliminary selection of appropriate ASD and VSD,the guiding of the locations and the releasing Amplatzer occluders and the observation of the instant curative effect.It is invaluable for effective evaluation and prognosis assessment.