经食管超声心动描记术在先天性心脏病镶嵌治疗中的应用  

Transesophageal echocardiography-guided hybrid procedure in treatment of congenital heart diseases

作　　者：杨智利[1] 陈莉[1] 胡杨柳[2] 赵景[1] 周翠翠[1] 

机构地区：[1]南昌大学第一附属医院超声科,江西南昌330006 [2]江西护理职业技术学院医学技术系,江西南昌330029

出　　处：《中国介入影像与治疗学》2013年第6期343-346,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察TEE在非体外循环下先天性心脏病镶嵌治疗中的临床应用价值。方法回顾性分析167例TTE初筛拟行先天性心脏病镶嵌治疗的患者,术前TEE检查进一步筛选患者,指导选择适当封堵器,术中TEE监测引导置入封堵器并评价其疗效。结果本组167例中,24例房间隔缺损(ASD)和121例室间隔缺损(VSD)成功完成镶嵌治疗,1例ASD和5例VSD术后即刻TEE可见一丝残余分流,术后3个月复查1例ASD和4例VSD残余分流消失,1例VSD右心室流出道血流速度稍加快,1例VSD术前无主动脉瓣反流,术后出现轻-中度反流。3例ASD和9例VSD镶嵌治疗不顺利,转体外循环。对1例ASD和2例VSD由于缺口过小而放弃治疗。7例VSD合并主动脉瓣脱垂直接放弃镶嵌治疗,转修补术。结论在非体外循环下先天性心脏病的镶嵌治疗中,TEE能为选择适应证和封堵器提供技术支持,实时监测指导及评价手术,降低手术风险,提高手术成功率。Objective To investigate the application value of TEE hybrid procedure for congenital heart diseases （CHD） without cardiopulmonary bypass. Methods Totally 167 patients with CHD were selected by TTE as preliminary screening and scheduled to undergo hybrid procedure. TEE was used for further selecting of the patients, choosing the right Amplat-zer device and monitoring the hybrid procedure, as well as for evaluation of therapeutic efficacy. Results Twenty-four pa-tients with atrial septal defect （ASD） and 121 patients with ventricular septal defect（VSD） got successful outcomes in the hybrid procedure. One case of ASD and 5 cases of VSD showed slight residual shunt by postoperative TEE examination. Three months later, the residual shunt of 1 case of ASD and 4 cases of VSD disappeared. One case of VSD showed blood flow of outflow tract of right ventricular a little faster. One case of VSD without preoperative aortic valve regurgitation showed postoperative mild-to-moderate regurgitation. Hybrid procedure failed in 3 cases of ASD and 9 cases of VSD, and then were closured under extracorporeal circulation. Hybrid procedure was gave up in 1 case of ASD and 2 cases of VSD because of too small gap of ASD or VSD, in 7 cases of VSD with aortic valve prolapse while were finally treated with surgi-cal repair. Conclusion In hybrid procedure of congenital heart diseases, TEE can provide technical support for the choice of patients and Amplatzer device, and monitoring, guiding, evaluating the surgery in real-time, reducing surgical risk, therefore improving the success rate of operation.

关 键 词：超声心动图描记术 经食管 心脏缺损 先天性 镶嵌治疗 

分 类 号：R654.2[医药卫生—外科学] R540.45[医药卫生—临床医学]