经食管超声心动图在合并动脉导管未闭的先天性心脏病中的应用研究  

Application research of transesophageal echocardiography in congenital heart disease complicated with patent ductus arteriosus

作　　者：刘会若[1] 尹立雪[2] 张瑞芳[1] 滑少华[1] 赵文增 文冰[3] 高珂[1] 孙梦娇[1] 

机构地区：[1]郑州大学第一附属医院超声科,450052 [2]四川省医学科学院.四川省人民医院心血管超声及心功能科,成都610072 [3]郑州大学第一附属医院心外科,450052

出　　处：《中华医学超声杂志（电子版）》2016年第7期513-518,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨经食管超声心动图(TEE)在引导动脉导管未闭(PDA)外科微创封堵术中的应用价值。方法选取2013年10月至2015年8月郑州大学第一附属医院术前经胸超声心动图(TTE)诊断合并PDA的先天性心脏病患者42例,动脉导管均呈管型或漏斗型,其中14例合并法洛四联症,9例合并隔瓣下型室间隔缺损,7例合并部分型心内膜垫缺损,12例合并肺动脉瓣狭窄。所有患者大动脉水平均呈左向右分流,29例合并中度以上房室瓣反流,13例患者合并肺动脉高压。手术方式为TEE引导下PDA封堵术+体外循环辅助下心内直视矫治术。术中心脏复跳后、术后6个月的房室瓣口反流面积以及肺动脉收缩压与术前麻醉状态下的同一参数比较采用独立样本t检验。结果在TEE精确引导下,41例患者动脉导管封堵成功。术后12个月随访时间内,所有成功封堵患者均无封堵器相关并发症的发生。1例患者因动脉导管内可见粥样硬化斑块形成,改补片法封闭动脉导管。首次心脏复跳后TEE显示:41例成功封堵的患者封堵器固定良好,无移位、脱落、残余分流情况发生;心室水平残余分流4例,其中1例合并法洛四联症、3例合并隔瓣下型室间隔缺损,即刻进行手术处理,再次心脏复跳后,该残余分流消失。其余患者均一次矫治成功。13例患者合并肺动脉高压,其肺动脉收缩压术中心脏复跳后与术前比较,差异无统计学意义(t=0.87,P>0.05);术后6个月复查肺动脉收缩压较术前明显下降,差异有统计学意义(t=4.90,P<0.01)。合并中度以上房室瓣口反流的患者,其瓣口反流面积术中心脏复跳后、术后6个月与术前比较,均明显减少,差异有统计学意义(二尖瓣:t=12.75、13.80,三尖瓣:t=17.65、19.94,P值均<0.01)。结论 TEE能够有效引导心脏外科医师进行PDA微创封堵术,具有安全、无放射线损伤、可操作性强等优点,可先于其他心内矫治术实施,以减少术中出血Objective To evaluate the value of transesophageal echoxardiography（TEE） in surgical micro-invasive patent ductus arteriosus（PDA） occlusion. Methods Totally 42 PDA cases diagonsed by transthoracic echocardiography（TTE） as tube type or funnel type complicated with other cardiac malformations（tetralogy of Fallot： 14 cases, under septal leaflet type ventricular septal defect： 9 cases, partial endocardial cushion defect： 7 cases, pulmonary stenosis： 12 cases） were entrolled in this study. All patients showed left to right shunt in artery level. 29 cases accompanied with moderate or severe atrioventricular regurgitation and 13 cases accompanied with pulmonary hypertension among 42 cases. The PDA occlusion was performed under TEE navigation and monitoring by cardiac surgeons to release the occlusion device and combined with open-heart surgical treatment under extracorporeal circulation auxiliary. We used an independent samples t-test to assess the difference of the same parameters about the preoperative and postoperative for six months, intraoperative heart rebeated and postoperative for six months, which included atrioventricular regurgitation area and pulmonary artery systolic pressure. Results TEE was used in preoperative and intraoperative procedures during micro-invasive surgical occlusion for more precise diagnosis of PDA and navigation and monitoring of occlusion procedures. Forty-one PDA cases were occluded successfully except one case occluded by surgical sticking patch due to sever PDA atheroselerosis. With 12 months＇ follow up, the complications with related occluder were not found. After the first heart rebeated, TEE revealed that 41 cases of successfully closed showed the occluder stayed firmly, there were no notable occluder-loss, no residual shunt, and 4 cases with residual shunt in ventricular level were found（1 case complicated with tetralogy of Fallot and 3 cases compicated with sub-septal leaflet type ventricular septal defect）, which were operated immediately again. The

关 键 词：超声心动描记术 经食管 外科手术 微创性 动脉导管未闭 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]