经食管超声心动图在经胸微创治疗室间隔缺损中应用价值  

Transesophageal echocardiography in minimally invasive transthoracic occlusion for ventricular septal defect

作　　者：刘会若[1] 张瑞芳[1] 滑少华[1] 赵文增 文冰[2] 高珂[1] 侯苏云 许建威[1] 孙梦娇[1] 

机构地区：[1]郑州大学第一附属医院超声科,郑州450052 [2]郑州大学第一附属医院心外科,郑州450052

出　　处：《中华实用诊断与治疗杂志》2016年第9期911-913,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家临床重点专科建设资助项目(2014年)

摘　　要：目的探讨经食管超声心动图(transesophageal echocardiography,TEE)在经胸微创封堵治疗室间隔缺损(ventricular septal defect,VSD)中的应用价值。方法44例VSD患儿,术前经胸超声心动图(transthoracic echocardiography,TTE)检查诊断单纯性膜周部VSD 34例(其中呈膜部瘤状18例)、嵴内型VSD 10例。采用TEE再次评估VSD大小,放置封堵器,实时动态评价封堵效果;术后3d及3、6、12个月采用TTE定期评价心内结构及功能,同步检测心电图、血常规及尿常规等。结果 44例中38例封堵成功,成功率为88%,其中33例放置等边型VSD封堵器,4例放置偏心型VSD封堵器,1例放置小腰大边型VSD封堵器;6例改行体外循环辅助下心内直视修补术。术后3d及3、6、12个月行TTE检查,无封堵器脱落、移位,严重心律失常发生。结论 TEE在经胸外科微创封堵术治疗VSD尤其是膜周部VSD和嵴内型VSD中有重要价值。Objective To evaluate the application value of transesophageat echocardiography （TEE） in transthoracic minimally invasive transthoracic occlusion on ventricular septal defect （VSD）. Methods In 44 VSD patients, 34 patients were diagnosed isolated perimembranous ventricular septal defect （PVSD） including 18 patients with membranous aneurysm, and 10 patients were diagnosed intercristal ventricular septal defect by preoperative transthoracic echocardiography （TTE）. After the size of VSD was reassessed by TEE, suitable occluders were selected and placed, and occlusion effects were dynamically evaluated. The cardiac structure and function were evaluated by TTE in 3 days, 3 months, 6 months and 12 months after operation. And electrocardiography was performed, and blood routine and urine routine indexes were synchronously detected. Results Of 44 cases, 38 cases were occluded successfully with the success rate of 88%, in which 33 cases were given equilateral VSD occluders, 4 cases were given VSD decentered VSD occluders, and 1 case was given thin-waist-big-side VSD occluder. Six cases failed and were converted to extracorporeal circulation auxiliary open-heart repair operation. All patients underwent TTE in 3 days, 3 months, 6 months and 12 months after operation, and no notable residual shunt, occluder-loss or arrhythmia was found. Conclusion TEE plays a vital and reliable role in minimally invasive transthoracic occlusion on VSD, especially for perimembranous and intercristal VSD.

关 键 词：室间隔缺损 经食管超声心动图 经胸微创封堵术 

分 类 号：R540.45[医药卫生—心血管疾病] R725.4[医药卫生—内科学]