经胸超声心动图下心导管法修补心房间隔缺损  

Transcatheter closure of secundum atrial septal defect with the Amplatzer septal occluder device under transthoracic echocardiogram

作　　者：魏盟[1] 王春生[2] 潘翠珍[2] 王齐冰[2] 金惠根[1] 薛小培[1] 

机构地区：[1]上海市第六人民医院心内科 [2]上海市心血管病研究所

出　　处：《临床心血管病杂志》2001年第7期298-300,共3页Journal of Clinical Cardiology

摘　　要：目的 :评价经胸超声心动图 ( TTE)是否可替代食管超声心动图 ( TEE)在经导管修补心房间隔缺损( ASD)术中指导封堵伞的定位。方法 :3 9例适合经导管法修补 ASD的患者入选 ,选用 Amplatzer封堵装置 ,局麻(小儿静脉麻醉 )下 ,在 X线透视和 TTE下进行手术。术后 2 4 h复查 TTE,2 2例术后 3～ 12个月进行了再次随访。结果 :4例未成功包括 2例 ASD实际直径过大 ,1例封堵伞不能到位 ,1例急性心包压塞 ;3 5例封堵成功 ,成功率为 89.7% ;无死亡及栓塞事件发生。3 3例 ( 91.7% )在 TTE指导下完成 ,仅 3例需要 TEE指导 (包括 1例未成功者 )。术后即刻 TTE见 3例存在少许残余分流 ,2 4 h后复查残余分流消失。 2 2例在术后 3～ 12 (平均 5 .5 )个月内复查 TTE,结果示右心房和右心室均有不同程度的缩小 ,平均肺动脉收缩压由术前的〔( 3 8.1± 6.0 ) mm Hg,1m m Hg=0 .13 3 k Pa)〕下降至术后的 ( 2 7.3± 4 .0 ) m m Hg,术前后差异有非常显著性意义 ( P <0 .0 1) ,未见封堵伞移位及新的房水平左向右分流 ,房室瓣功能正常。结论 :90 %以上的 ASD病例可在 TTE指导下完成。 ASD缺损边缘残留组织少 ( 5 m m左右 )或组织菲薄及 ASD直径 >3 4 mm者还应采用 TEE指导手术 ,以免封堵伞位置不良 。Objective: Transesophageal echocardiogram (TEE) is requisite for safely releasing atrial septal defect occlusion device, including the Amplatzer, a new occlusion device. However, patients may get some sufferinges during TEE procedure under local anesthesia, and patients′ medical expenditure will increase either. The purpose of this study was to investigate whether transthoracic echocardiogram (TTE) can replace TEE during this procedure. Method: Thirty nine patients were enrolled in the study. ASD occlusion were achieved with the Amplatzer occluder under X ray and TTE. TTE was performed immediately before and 24 hours later after the procedure and again TTE was done for 22 patients at 5.5 (3~12) months in average after the operation. Result: The procedure was failed in 4 patients, in two the ASD diameter was too big to be closed, in one the occluder was unable to be implanted properly and in one complicated with acute cardiac tamponade. Thus closure of ASD was performed in 35( 89.7 %) patients. The average diameter of the occluder was 12~38( 26.4 ± 4.0 )mm.The occlusion were successfully achieved with TTE in 33( 91.7 %) patients, only in 3 patients who needed help of TEE including 1 failed case. Faint residual shunt detected by echocardiogram has been seen only in 3 cases immediately after releasing the occluder, and it disappeared 24 hours later. The right atria and the ventricles became smaller compared with those before ASD closure, the systolic pulmonary pressure in average decreased significantly from ( 38.1 ± 6.0 ) to ( 27.3 ± 4.0 ) mmHg (P< 0.05 ) without new residual shunt and all occluders get their original place. Conclusion: ①The Amplatzer occluder is very efficient and user friendly with a very high success.②Most ASDs(more than 90%) which are suitable for the Amplatzer occluder can be safely implanted under guidance of TTE. ③In those with a very fragile and small septal rim(around 5 mm) and with a diameter of ASD>34 mm, TEE should be used in order to avoid the

关 键 词：房间隔缺损 心脏导管插入术 超声心动描记术 

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