多中心应用两种超声心动图指导房间隔缺损封堵治疗情况的比较  

A multicentre study: Trancatheter closure of secundum atrial septal defect guided by transthoracic echocardiography

作　　者：张玉顺[1] 马业新[1] 肖建民[1] 马东江[2] 李寰[1] 张军[3] 李军[3] 

机构地区：[1]华中科技大学同济医学院附属同济医院心内科,湖北武汉430030 [2]西安交通大学医学院第一附属医院心内二科,陕西西安710061 [3]第四军医大学西京医院,陕西西安710032

出　　处：《心脏杂志》2008年第2期158-161,共4页Chinese Heart Journal

摘　　要：目的评价经胸超声心动图指导房间隔缺损（ASD）封堵治疗的效果。方法总结18个医院ASD封堵治疗患者2108例，按经食管超声心动图（TEE）和经胸超声心动图（TTE）检查和指导封堵治疗的不同，分为TEE组和TTE组。其中TEE组504（男197，女307）例，年龄12—65（28±15）岁；TIE组1604（男621，女983）例，年龄1-70（23±11）岁。结果TEE组和TTE组ASD最大直径为（22±10）mm vs （21±11）mm，所植入封堵器的大小为（26±8）mm vs （27±9）mm，手术技术成功率95．4％vs 95．9％，微-少量残余分流率即刻为13％ vs 12％，随访3—6月为2．8％vs 2．9％，两组相比均无统计学差异。但手术操作时间TTE组明显短于TEE组（P〈0．01）。TEE组和TTE组发生心包填塞均为0．6％，发生脑出血或脑梗死为0．2％ vs 0．1％，短暂房室传导阻滞为2．6％ vs 1．7％。术后发生阵发性房颤为1．2％ vs 1．7％，两组相比均无显著统计学差异。结论两种超声心动图指导ASD封堵术均成功率高，安全性好，无显著差异。但TTE较TEE指导ASD封堵治疗操作更为简便，可显著缩短手术时间。AIM To evaluate the efficiency of trancatheter closure of secundum atrial septal defect （ASD） guided by transesophageal echocardiography （TEE） or transthoracic echocardiography （TIE）. METHODS We analyzed the outcome of 2 108 patients who underwent percutaneous transcatheter closure of ASD with atrial septal occluder （ASO） from the centre of cardiovascular disease in 18 hospitals. According to the guidance type in closure procedures, the patients were divided into two groups, TEE or TTE. Five hundred and four patients were enrolled in TEE group [ 197 male and 307 female, mean age （28 ± 15） years] and 1 604 patients in TIE group [621 male and 983 female, mean age （23 ± 11 ） years ]. RESULTS No significant difference was found between the two groups in the largest ASD diameter [（22±10）mmvs （21±11）mm], the size of implanted ASO [（26±8）mm vs （27 ± 9）mm], the rates of complete closure of ASD and trivial to small residual shunting immediately or during the 3-6 month follow-up. But the procedural time of closure procedures was significantly shorter in TIE than that in TEE （P 〈0.01 ）. No significant difference was seen between the two groups in complications related to the procedure, including pericardial tamponade （0.6% vs 0. 6% ）, ent atrial ventricular block （ 2.6% vs 1.7% ） and paroxysm atrial stroke （0.2% vs 0.1% ）, transi- fibrillation （ 1.2% vs 1.7% ）.CONCLUSION Guidance with TEE or rITE is sage and of a high success rate, with no significant difference. But compared with guidance by TEE, transcatheter closure of ASD under rITE is easier for operation and effective shortening of operation time.

关 键 词：房间隔缺损 介入治疗 封堵 

分 类 号：R541.1[医药卫生—心血管疾病]