经胸超声指导Amplatzer封堵器介入治疗先心病的应用价值

目的探讨经胸超声(TTE)指导Amplatzer封堵器介入治疗房间隔缺损(ASD),室间隔缺损(VSD)及动脉导管未闭(PDA)的应用价值。方法术前应用TTE筛选封堵术适应症33例先心病,其中23例ASD、6例VSD、4例PDA。术中用TTE监测指导释放封堵器,即刻观察疗效。术后进行定期随访。结果21例ASD、5例VSD、4例PDA封堵成功,2例ASD及1例VSD封堵失败,总成功率为90.91%(30/33)。21例ASD 病例中,14例选用TTE测量缺损最大径与球囊测量最大伸展径比较,TTE测量缺损最大径与球囊测量最大伸展径比较有明显相关性(r=0.563,P<0.05)。7例选用TTE测量缺损最大径基础上加3-4 mm作为封堵器大小的选择。筛选6例膜周部VSD,5例封堵成功,1例封堵失败。VSD例数虽少,但发现VSD形态变化多,VSD右室面形态各一。筛选4例PDA封堵成功。30例成功封堵术封堵即刻无残余分流为93.33%(28/30),6.67%有低速少量分流(2/30)。术后一周复查心脏均有一定缩小,6个月复查心脏恢复至正常范围。结论TTE可用来筛选ASD、VSD、PDA封堵术病例,术中检测指导Amplatzer封堵器定位和释放,观察即刻疗效,治疗可靠;术后进行疗效评价有较大价值。

Value of Transthoracic Echocardiography(TTE) in Interventional Treatment of Congenital Heart Diseases

Objective To study the applied value of transthoracic echocardiography (TTE) in the interventional treatment of secundum atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA) with Amplatzer occluders. Methods TTE study was performed before the interventional therapy to select appreciated cases including twenty-three cases with ASD, six cases with VSD and four cases with PDA. The defect closures were monitored and guided with TTE throughout the procedures. Immediate evaluation was carried out within 24 hours, and all cases were followed-up. Results The occlutions of twenty-one cases with ASD, five cases with VSD and four cases with PDA were successful, two cases with ASD and one case with VSD failed and the achievement ratio was 90. 91% ( 30/33) . In fourteen cases with ASD, The sizes of ASD measured by echocardiography and balloon were compared. The correlation between the maximum echo diameter and the maximum extension diameter of the defects measured by balloon method was excellent (r=0. 563, P<0. 05). the size of occluders was selected just according to the atrial septal defect size measured echocardiographically plus three to four millimeters in seven cases with ASD. There were six cases with perimembranous VSD selected, five of whom were successfully occluded and one of whom failed. Four cases with PDA were successfully occluded. Echocardiography performed at once after the closure showed that the umbrella devices were stable with no shunt in 28/30, (93. 33%) and a small shunt in 2/30 (6. 67%). In all cases, the heart sizes minified a week after the procedures and they recovered to normal sizes after six months follow-up. Conclusions TTE is a useful approach for the preliminary selection of appropriate ASD, VSD and PDA and for guiding the locations and releasing Amplatzer occluders and observing the instant curative effect. It is invaluable for effective evaluation in follow-up.