食道超声引导经胸室间隔缺损封堵术的临床体会

【】 目的 总结食道超声引导经胸非体外循环下微创封堵术治疗室间隔缺损(VSD)的临床经验。方法 自2011年3月至2015年3月我院经食道超声引导室间隔缺损封堵术患者45例,男28例,女17例；年龄7个月～9岁(4.7±1.9)岁；体重4.9～25.6(13.5±5.8)kg。膜部VSD30例,嵴下型VSD6例,干下型VSD4例,肌部VSD5例。VSD直径4.7～11.5(5.8±1.2)mm。全组均采用胸骨下端3～5cm小切口进胸,术中食道超声引导下,送入导引钢丝及输送鞘管经右心室-VSD进入左心室,沿输送轨道送入封堵器完成VSD封堵术,术毕立即经食道超声全面评估手术效果。结果 全组43例封堵成功(95.6%),2例术中转为体外循环下常规手术(4.4%)。术后封堵器边缘少量残余分流2例(4.4%),3个月后复查消失。术后40例随访12个月(88.9%,40/45),无传导阻滞及主动脉瓣返流,无近期死亡。 结论 食道超声引导室间隔缺损封堵术是一种简单有效的治疗方法,多次操作后即可掌握操作要点,术中需结合超声对手术效果进行评估。

Clinical experience of minimally invasive transthoracic closure of ventricular septal defects under guidance of the esophagus echocardiography

Objective To sum up the clinical experience of minimally invasive transthoracic closure of ventricular septal defects(VSD) under guidance of the esophagus echocardiography(TEE) without cardiopulmonary bypass.Methods 45 patients with VSD,28 males and 17 females,aged from 7 months to 9years,averaging (4.7±1.9) years.The weight of these patients ranged from 4.9 to 25.6 kg (13.5±5.8) kg.The diameter of these VSD ranged from 4.7 to 11.5 mm(5.8±1.2)mm.All patients adopt the lower sternal incision with 4 or 5 cm.Being guided with TEE,the devices was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. The devices would be released if the heart rhythm was normal and affect of the operation was assessed by TEE.Results The procedure was completed successfully in 43 cases(95.6%), Tow patients were converted to traditional surgical closure with CPB(4.4%). Tow patients had tiny residual shunt after operation and vanished after three months.The 12 months follow-up period,neither complete atrioventricular heart block nor aortic insufficiency was found in any patient.Conclusions The minimally invasive device closure of VSD under TEE guidance is a simple and effective treatment,operation more times can master the operation points and TEE is important in operation.