非X线下经胸壁超声全程引导经导管房间隔缺损封堵术的应用研究

目的 探讨非X线下、经胸超声心动图常规经胸二维超声(TTE)和实时三维超声(RT-3DE)]全程引导经导管房间隔缺损封堵术(TCASD)的方法学要点和临床应用价值.方法应用GE Vivid 7彩色超声诊断仪,普通二维及矩阵3V经胸探头,在完全脱离X线条件下,实时引导11例房间隔缺损(ASD)患者的TCASD术.在常规二维多切面观察的基础上,结合RT-3DE引导多功能导管经腔静脉进入右房;引导导管经缺损进入左房并抵左上肺静脉;引导输送鞘准确进入左房中部;引导封堵器双面伞在左房展开,贴靠入位并准确释放.同期与58例条件类似行常规X线和TTE引导的TCASD患者比较.结果所有手术均顺利完成,无心包填塞等重大并发症发生,与对照组相比,除手术时间显著延长外,研究组在手术即刻及随访3 d、3个月内,残余分流、封堵器移位、房室瓣反流、栓塞及心律失常等并发症发生率与对照组比较差异无统计学意义.结论非经X线条件下、TTE结合RT-3DE全程引导TCASD是安全、经济、实用的超声介入技术,可减少对X线引导封堵的依赖性,对孕妇和儿童实施封堵治疗减少辐射伤害尤为有效.

Application of transthoracic echocardiography in guiding transcatheter closure of atrial septal defects without X-ray

Objective To evaluate the feasibility and efficiency of transthoracic echocardiography(TTE) combined with real-time three dimensional echocardiography(RT-3DE)in guiding transcatheter closure of atrial septal defect(TCASD)without X-ray.Methods Eleven patients with atrial septal defects(ASD)underwent the procedure of TCASD guided by TTE combined with RT-3DE.The position of the catheter and transporting sheath,the location and deploying of ASD occluder(ASO)were monitored by muhisection echoscan.especially in RT-3DE.The results were compared with those guided by conventional method(TTE and X-ray).Results All the operations were held successfully.The complications of cardiac tamponade,shedding of occluder,residual shunt,atrioventricular valve regurgitation,embolism and arrhythmia were not observed.Compared with the conventional procedure of the control group,the operation time was significantly prolonged(65.76±14.15)min versus(45.50±20.88)min,P＜0.000)].Conclusions TCASD was tested to be safe and efficient guided by TTE combined RT-3DE without X-ray,especially for children and pregnant women.It may be expected used widely in the future independently from X-ray.