经胸超声心动图指导软缘房间隔缺损封堵的价值  

Value of transthoracic echocardiography on guiding occlusion of soft-rim atrial septal defect

作　　者：张军[1] 李军[1] 石晶[1] 张玉顺[2] 左健[3] 代政学[2] 李寰[2] 朱霆[1] 

机构地区：[1]第四军医大学西京医院超声诊断科,西安710032 [2]第四军医大学西京医院心脏内科,西安710032 [3]第四军医大学西京医院心血管外科,西安710032

出　　处：《中华超声影像学杂志》2008年第6期494-497,共4页Chinese Journal of Ultrasonography

摘　　要：目的评价经胸超声心动图（TTE）指导软缘房间隔缺损（ASD）封堵术的可行性和作用。方法62例软缘ASD患者，术前用彩色多普勒超声心动图结合组织谐波功能经胸测量各切面ASD大小及观察周缘软硬情况，将菲薄且来回明显摆动、无支撑力的软缘剔除测量“ASD支撑径”。再根据ASD大小和“ASD支撑径”大小综合判断选择适当的封堵器型号。封堵器释放后测量其腰部大小，并与术前TTE测量的ASD最大径以及“ASD支撑径”进行比较。结果TTE术前检查ASD最大径11～35mm[平均（21．6±5．2）mm]，剔除软缘后的“ASD支撑径”15～37mm[平均（25．6±5．0）mm]，选用的封堵器18～44mm[平均（30．7±5．5）mm]，释放后封堵器腰径13-35mm[平均（24．2±5．6）mm]。TTE测量的ASD最大径与释放后封堵器腰径相关性良好（r=0．86，P〈0．0001）；TTE测量的剔除软缘后“ASD支撑径”与释放后封堵器腰径相关性进一步改善（r=0．89，P〈0．0001）。所有患者ASD封堵器固定牢固，无脱落。结论TTE结合组织谐波功能可以测量软缘ASD大小以及剔除软缘后的“ASD支撑径”大小，是指导软缘ASD封堵的简便、可行的方法。Objective To evaluate the feasibility and effect of transthoracic echocardiography（TTE） on guiding the occlusion of the soft-rim atrial septal defect（ASD）. Methods Sixty two patients with the soft-rim ASD were enrolled. The size of ASD was measured and rim of ASD was observed by TTE on various views by using color Doppler system with tissue harmonic function before occlusion, and filmy rim of ASD with flapping which could not sustain occluder was eliminated. The size of occluder was selected by integratively judging the size of ASD and ＂sustainable diameter of ASD＂. The waist size of occluder was measured after releasing occluder and compared with the longest diameter of ASD and ＂sustainable diameter of ASD＂ measured by TTE. Results The longest diameter of ASD measured by TTE before occlusion was 11-35 mm[average （21.6± 5.2）mm], the ＂sustainable diameter of ASD＂ was 15-37 mm[average （25.6 ± 5.0）mm], the size of selected occluder was 18-44 ram[average （30.7 ± 5.5）mm] and the waist size of released occluder was 13-35 mm[average （24.2 ± 5.6）mm]. Fine correlation was existed between the longest diameter of ASD measured by TTE and the waist size of released occluder （ r = 0.86, P 〈0. 0001）. Morever,improved correlation was found between the＂sustainable diameter of ASD＂ measured by TTE and the waist size of released occluder（ r = 0.89, P 〈0. 0001 ）. Occluder was firmly fixed without falling in all patients. Conclusions TTE with tissue harmonic function can be used to measure the size of soft-rim ASD and the＂sustainable diameter of ASD＂. It is a feasible, and effective method on guiding occlusion of soft-rim ASD.

关 键 词：超声心动描记术 房间隔缺损 封堵 

分 类 号：R686[医药卫生—骨科学]