经胸联合经食道超声心动图在成人房间隔缺损介入封堵术中的临床价值

目的:评价经胸超声心动图(TTE)联合经食道超声心动图(TEE)在Amplatser封堵器介入治疗成人房间隔缺损(ASD)中的临床应用价值。方法:应用TTE筛选符合介入封堵治疗标准的继发孔型房间隔缺损患者33例,其中对于筛选出缺损直径≥25mm、多孔房缺以及软边显示不清楚的患者行TEE检查,确认缺损个数、直径及边缘情况,对于符合条件者行Amplatser封堵器介入治疗,分析患者封堵成功率、术后残余分流情况及并发症发生情况。结果:33例患者中16例TTE测量缺损直径<2 5mm,直接封堵成功;2例二孔型房缺,4例缺损边缘显示不清者,11例直径≥25mm者均进一步行TEE检查,根据TEE检查结果选择合适封堵器封堵,其中1例缺损直径达35mm,尝试封堵未成功,转外科行修补术。所有封堵成功的患者即刻TTE检查均未见残余分流,分别于术后24h、7d及1、3、6个月查超声心动图均无残余分流,无溶血现象,各瓣膜未受影响。16例同时行TEE及TTE检查的单孔房缺患者,TEE测量ASD最大直径较TTE测量值偏大,差异有统计学意义(P<0.05)。结论:经TTE联合TEE检查指导房间隔缺损介入封堵治疗,可进一步提高手术成功率,有利于该项技术在临床的推广应用。

Application of transthoracic and transesophageal echocardiography in interventional occlusion for atrial septal defect

Objective:To evaluate the application of transthoracic and transesophageal echocardiography in interventional occlusion for atrial septal defect(ASD).Methods:A total of 33 patients with ASD were carefully selected.Patients with the defect diameter ≥ 25 mm diameter,multiple ASD and unclear soft edge were examined with transesophageal echocardiography,in order to record the number,diameter and the edge defect.Qualified patients with ASD were occluded by use of Amplatzer.And the success rate,residual shunt and complications were observed.Results:A total of 16 patients with diameter < 25 mm had successful treatment;2 patients with two-hole-defect,4 cases with unclear edge and 11 cases with diameter ≥25 mm were detected by transesophageal echocardiography.According to the detection result,suitable occluder was selected.One case with diameter of 35 mm failed to occlusion,and turned to surgical repair.Transthoracic echocardiography after surgery showed no residue shunt,and echocardiography after 24 h,7 d,1 month,3 months and 6 months all showed no residue shunt,hemolysis or effect on valave.Conclusion:Transthoracic echocardiography combined with transesophageal echocardiography can increase success rate of interventional occlusion for ASD,and is worthy clinical application.