TEE在外科微创房、室间隔缺损封堵术中的应用

目的探讨TEE引导下外科微创封堵治疗房间隔缺损(ASD)、室间隔缺损(VSD)的价值。方法 58例ASD和129例VSD患者接受TEE引导下外科微创封堵治疗。术中行胸壁小切口暴露心脏,于TEE监测下选择右心房或右心室穿刺点,指引动脉止血鞘通过缺口后释放封堵装置,待TEE多切面证实封堵器位置良好、无明显残余分流及瓣膜并发症后释放封堵器。结果 58例ASD均封堵成功,术后即刻TEE见8例封堵器周围微量残余分流。129例VSD中,114例VSD封堵成功,其中19例术后即刻TEE检查见残余分流,2例右心室流出道血流速度增快,1例变更右心室壁穿刺点后导丝顺利进入缺口;15例转行体外循环下心内直视修补术。结论 TEE可用于指导外科微创封堵治疗ASD和VSD,包括测量缺损大小和位置、选择封堵器型号、确定手术路径、引导封堵器释放和评估治疗效果。

Application of TEE in minimal invasive surgical closure of atrial and ventricular septal defects

Objective To explore the value of TEE-guided surgical minimal invasive closure of atrial septal defects (ASD) and ventricular septal defects (VSD). Methods Totally 58 patients with ASD and 129 patients with VSD underwent TEE-guided minimal invasive surgical closure. After small chest wall incision, under TEE monitoring, the accurate puncture point of right atrium or right ventricular wall was selected, then arterial hemostatic sheath passed through the gap. Multi-section TEE was used to confirm that the occluder position was suitable. Then the occluder was released when no significant residual shunt and valve complication was observed. Results Minimal invasive surgical closure was successfully performed in all 58 ASD patients, with small residual shunts were found in 8 cases. Minimal invasive surgical closure of VSD was successfully performed in 114 patients but failed in 15 patients who then underwent open heart repair. Among 114 patients with successfully occluded VSD, 19 patients displayed minimal residual shunt, 2 patients displayed right ventricular outflow tract blood flow velocity increased, and the guide wire smoothly entered the gap in 1 patient after changing the right ventricular wall puncture point. Conclusion TEE is useful for minimal invasive surgical closure of ASD and VSD, included measuring the size and position, choosing the occluder size, determing operative approach, guiding occluder released and evaluating instant therapeutic effect.