联合运用经胸超声心动图和经食道超声心动图指导经皮房间隔缺损封堵术的可靠性评估  

Percutaneous Transcather Closure of Atrial Septal Defect Guided by Transthoracic Echocardiography and Transesophageal Echocardiography

作　　者：丁寻实[1] 冯沅[1] 胥建君[1] 陈玉成[1] 曾智[1] 饶莉[1] 

机构地区：[1]四川大学华西医院心内科,成都610041

出　　处：《四川大学学报（医学版）》2010年第4期644-647,共4页Journal of Sichuan University(Medical Sciences)

基　　金：国家"十五"科技支撑计划(2007BA105B03)资助

摘　　要：目的评估联合使用经胸超声心动图(TTE)和经食道超声心动图(TEE)指导经皮房间隔缺损(ASD)封堵术的可靠性。方法 120例患者入选该研究。所有患者均接受术前TTE及TEE检查,术中TTE引导下房间隔封堵器释放。根据房间隔封堵器(ASO)直径分为2组,≥24 mm为A组,<24 mm为B组,同时每组又以ASD前缘是否缺失分为两个亚组。所有患者于封堵后24 h、1月、3月、6月随访TTE及心电图检查。结果 ASD封堵成功率在两组分别为94%和100%。A组中ASD的TEE测值与TTE测值差值为(2.7±2.8)mm,B组为(1.7±2.0)mm,P<0.05。ASO直径分别与TEE和TTE所测ASD最大径的差值,A组分别为(4.87±1.10)mm和(7.51±2.72)mm,B组分别为(4.20±0.80)mm和(5.89±2.26)mm,P均<0.05。相关分析提示TEE测值与ASO直径的相关性较TTE测值与ASO直径的相关性高。回归分析提示TEE测值和TTE测值与ASO直径有线性回归关系。ASD前缘有或无的患者封堵成功率比较差异无统计学意义。A组中4例封堵失败,1例出现封堵器移位,1例出现Ⅱ度二型房室传导阻滞,1例出现脑卒中;B组未发生并发症。结论术前TTE联合TEE检查、术中TTE介导下ASD封堵成功率高,并发症较少,是一种有效、安全的ASD封堵指导方法,对于ASD前缘缺如的患者同样适用。Objective To evaluate the reliability of the combined use of TTE and TEE in guiding percutaneous closure of atrial septal defect.Methods A total of 120 patients were recruited,all accepting TTE and TEE examinations before surgery.The release of ASD occluders was guided by TTE.The patients were divided into two groups.Patients in Group A received ASD occluders with ≥24 mm diameter.Group B received ASD occluders with <24 mm diameter.Each group comprised patients with and without retroaortic rim.The patients were followed up with TTE and ECG examinations 24 h,1,3 and 6months after the procedure.Results ASD closure was successful for 94% and 100% of the patients in group A and group B,respectively.The difference of the ASD diameter measured by TEE and TTE was(2.7±2.8) mm in group A and(1.7±2) mm in group B,P<0.05.The ASD diameter measured by TEE had a (4.87±1.10) mm and(4.2±0.80) mm difference with the diameter of ASD occluders for patients in Group A and Group B,respectively(P<0.05).The ASD diameter measured by TTE had a(7.51±2.72) mm and(5.89±2.26) mm difference with the diameter of ASD occluders for patients in Group A and Group B,respectively(P<0.05).The ASD diameter measured by TEE had a greater correlation coefficient with the ASD occluder diameter than that measured by TTE.The ASD diameters measured by TEE(x1) and TTE(x2) were both linearly correlated with the ASD occluder diameter(y).There was no difference in the successful rate of ASD closure between the patients with and without deficient retroaortic rim.In group A,the procedure failed in 4 patients;misalignment of the ASD occlude occurred in one patient;one patient suffered from second degree type Ⅱ atrio-ventricular block;one patient had ischemic cerebral stroke.No such complications occurred in group B.Conclusion The combined use of TTE and TEE before the intervention procedure and the release of ASD occluder guided by TTE enables high successful closure rate with little complication.It is an effective and safe method.It can be performed in pa

关 键 词：经胸超声心动图 经食道超声心动图 房间隔缺损 可靠性 

分 类 号：R541.1[医药卫生—心血管疾病]