经食管超声心动图在外科微创治疗继发孔型房间隔缺损封堵术中的应用

目的探讨TEE在外科微创置入Amplatzer封堵器治疗继发孔型房间隔缺损（ASD）中的应用价值。方法对术前经TTE及TEE筛选的22例继发孔型ASD患者行外科微创封堵术,在TEE完成治疗全程,包括引导、监测和评估,封堵器选择、术中鞘管输送、封堵器释放及术后即刻手术效果评价。结果采用外科微创封堵术成功治疗21例患者,术后即刻TEE显示封堵器位置正常,塑形良好,无残余分流及并发症。TEE测量ASD最大径为（20.14±7.35）mm,与术中所用封堵器大小（26.66±8.70）mm]相关性良好（r=0.949,P〈0.0001）。1例患者术中TEE显示不适于微创封堵,改行小切口外科修补术获得成功。封堵术后TTE随访3个月,封堵器位置固定,无移位,无残余分流。结论 TEE在继发孔型ASD外科微创封堵治疗术中具有重要应用价值。

Application of transoesophageal echocardiography in the minimally invasive surgical occlusion of secondary atrial septal defect

Objective To observe the value of TEE in minimally invasive surgical closure of secondary atrial septal defects (ASD). Methods Twenty-two ASD patients were selected by TTE and TEE before operation. Minimally invasive surgical closure was performed on all the patients with guidance of TEE, including occluder selection, catheter sending, occluder release and evaluation of the effect immediately after operation. Results TEE guided minimally invasive surgical closure was successful in 21 patients. Immediate TEE after operation showed that the occluders were in proper site and shape, and no complications occurred. The largest diameter of ASD (20.14±7.35]mm) measured with TEE was positively correlated with the size of occulders used in operation (26.66±8.70mm, r=0.949, P<0.0001). TEE showed that 1 patient was not suitable for occlusion, and then surgical repair was performed. The patients were followed up for 3 months with TTE, neither displace of occluders nor residual shunt was found. Conclusion TEE plays an irreplaceable role in minimally invasive surgical closure of secondary ASD.