经胸超声心动图对非体外循环房间隔缺损封堵术的作用

目的评价经胸超声心动图(TTE)对非体外循环房间隔缺损(ASD)封堵术的指导作用。方法应用心脏彩色多普勒超声诊断仪术前经胸测量房间隔缺损最大直径以及周缘情况;TTE法指导非体外循环经右胸ASD封堵术,评价封堵器牢固程度以及有无残余分流;术后即刻、术后1周及术后3个月TTE观察封堵器位置及有无分流。结果术前TTE测量ASD最大直径为11~48mm[(26.76±10.53)mm],封堵器大小为16~58mm[(34.35±11.54)mm]。除2例术后三天及术后1h脱落改行直视修补术外,其余38例均一次封堵成功,成功率95%。应用此方法,缺损最大直径大于30mm的病例的疗效与小于30mm的病例疗效无差别。结论在非体外循环房间隔缺损封堵术中经胸超声心动图在术前筛选病例、测量缺损大小、术中指导手术全过程以及术后追踪随访病例均具有重要的指导作用。

Effect of blocking of atrial septal defect without extracorporeal circulation evaluated by transthoracic echocardiography

Objective To evaluate the effect of blocking of atrial septal defect (ASD) without extracorporeal circulation by transthoracic echocardiography (TTE). Methods The most defect expand diameter and circumferential information was measured by TTE preoperatively. All process of occlusion from right chest was monitored by TTE. Firmness of occluder and residual shunt was scanned too. The location of occluder and with or without shunt was observed by TTE the moment just after operation, one week after operation, and three months after operation. Results The most extent diameter of ASD were 11-48 mm ( mm) before operation. Occluder were 16-58 mm ( mm). 38 patients were successfully implanted only one time except two exfoliation three days and one hour after operation. The two patients were changed to operation by euthyphoria. Success ratio was 95%. Curative effect is not very different between the patients whose most defect expand diameter were more 30 mm and the patients whose most defect expand diameter were less than 30 mm. Conclusion The ASD occlusion detected by TTE without extracorporeal circulation have important role in screening and measuring the diameter of defect part, directing the course of operation, and follow-up after operation.