经食管超声心动图在微创室间隔缺损封堵治疗中的应用

目的 评价经食管超声心动图(transoesophageal echocardiography,TEE)在微创外科室间隔缺损封堵治疗中的临床价值.方法 经胸超声心动图检查粗筛27例室间隔缺损(VSD)患者,拟行微创外科非体外循环下封堵治疗.术前行TEE,根据VSD位置、类型、大小选择合适的封堵器;术中TEE引导封堵器放置,评价即刻封堵效果;术后1周内复查.结果 3例患者术前TEE剔除,20例患者封堵成功,TEE显示19例无残余分流,1例微量残余分流;4例患者转体外循环进行VSD修补,其中2例有残余分流,2例出现主动脉瓣反流;20例微创封堵成功患者术后1周内超声随访,均见封堵器位置正常,无残余分流,左心室重构改善,三尖瓣反流程度减轻,肺动脉压力下降.结论 TEE对选择适合行微创封堵的VSD患者、选择封堵器大小、协助封堵器的释放、评价疗效均有重要作用.微创VSD封堵安全、有效.

Role of transoesophageal echocardiography on perventricular closure of ventricular septal defects

Objective To evaluate the clinical value of transoesophageal echocardiography on perventricular closure of ventricular septal defects(VSD).Methods Transoesophageal echocardiography (TEE)was performed in 27 patients with VSD diagnosed by the transthoracic echocardiography examination (TTE)and prepared to receive perventricular closure of VSD for the purposes of choosing the appropriate occluder before VSD closure and guiding occluder release during the operation and evaluating the post operative effects of VSD closure 1 week post operation.Results Three patients with VSD not suitable for perventrieular VSD closure according to TEE results were not operated,perventricular closure of VSD were successfully performed in 20 patients and minimal residual shunt was seen in 1 patient post operation,perventricular closure of VSD failed in 4 patients and these patients received surgical closure.TEE at 1 week post successfully with perventricular closure of VSD in the 20 patients showed that there were no residual shunts and the pulmonary artery pressure was significantly lower post operation compared to that of preoperation value.Conclusion TEE is helpful in choosing the suitable patients and occlude size,guiding occlude release and evaluating the post operative results for perventricular closure of ventricular septal defects.