经食管超声心动图在中央型房间隔缺损微创外科封堵术中的应用

目的采用经食管超声心动图（TEE）引导中央型房间隔缺损微创外科封堵术，评价TEE在该手术中的临床应用价值。方法经胸超声心动图筛查选取中央型房间隔缺损（ASD）患者37例在河南省商丘市第一人民医院心外科行微创外科封堵术。全身麻醉状态下术前TEE再次筛查手术适应证患者，观察ASD的位置、大小、形态、各切面残余径线，准确定位，术中检测封堵全过程，术后即刻评价封堵效果。术后3个月、6个月、1年随访复查，观察有无封堵器移位脱落，有无残余分流及其他并发症。结果术前经TEE再次筛查发现1例下腔型ASD，随改为体外循环下修补；36例患者行微创外科封堵术，其中术中封堵失败1例，后改为体外循环下修补，封堵成功率为97.2%（35/36）；余35例患者应用TEE与TTE所测ASD大小各参数无明显差异，在TEE引导下封堵成功，术后即刻评价发现有2例出现少量残余分流，术后 3个月复查1例仍存在微量残余分流，余34例封堵器位置固定、完全闭合，闭合率为97.1%（34/35），右心大小及功能明显改善，各瓣膜功能及心功能正常，无严重传导阻滞发生。结论TEE应用于继发孔中央型ASD微创外科封堵术，术前准确筛查定位，与术中所置封堵器大小及位置相吻合，术中全程监测，不影响手术视野，引导封堵器的放置，术后即刻评价疗效，为心外科医生提供可靠信息。

Application of transoesophageal echocardiography in the central type atrial septal defect occlusion during minimally invasive surgery

ObjectiveTo observe the application of transesophageal echocardiography（TEE） guide the central type atrial septal defect occlusion during the minimally invasive surgery, and to evaluate the clinical value of TEE in the operation. MethodsTotally 37 patients were studied in the first people′s hospital of Shangqiu city cardiac surgery. We reassessed the sizes of the atrial septal defects and the margins, the suitable occluders by TEE, the atrial septal defect location, size, shape, each section of residual diameter, etc.After 3 months, 6 months, 1 year, patients were followed up to observe whether the occluder shift or off, with or without residual shunt and other complications. ResultsAfter preoperative TEE screening found inferior vena type atrial septal defect 1 case again.The occluder was successfully implanted in 35 patients. 2 patients were found with trace residual shunt and only 1 patient was found residual shunt after 3 months. Follow up at intervals showed that the occluders stayed firmly. There was no residual shunt or valve regurgitation. ConclusionTransesophageal echocardiography can guide minimally invasive closure.