超声心动图检查继发孔型房间隔缺损封堵术后并发症的诊断价值  

Diagnostic Value of Echocardiography for Postoperative Complications After Occluding the Secundum Atrial Septal Defects

作　　者：邢佳怡 王建德[1] 田莉莉 段福建[2] 朱振辉[1] XING Jiayi;WANG Jiande;TIAN Lili;DUAN Fujian;ZHU Zhenhui(Department of Ultrasonography,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China;不详)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声影像中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉科,北京市100037

出　　处：《中国循环杂志》2020年第1期72-77,共6页Chinese Circulation Journal

摘　　要：目的:研究超声心动图检查继发孔型房间隔缺损封堵术后并发症的应用价值。方法:选取我院2009年7月至2018年7月确诊继发孔型房间隔缺损并行经导管或经胸封堵术的患者3910例,所有患者术前经胸超声心动图(TTE)或经食管超声心动图(TEE)诊断筛选适应证,术中经经胸超声心动图或经食管超声心动图监测,术后复查经胸超声心动图,观察评价封堵器形态位置,评估相关并发症。结果:3910例行房间隔封堵术的患者中,封堵器脱落8例(0.20%),均急诊转外科修补治疗。心脏穿孔/磨蚀事件共8例,其中主动脉窦-右心房瘘1例(0.03%),经皮封堵治疗成功;二尖瓣前叶穿孔2例(0.05%),予随诊观察7年未特殊处理;心脏穿孔或心房壁损伤5例(0.13%),其中1例死亡(0.03%),4例行心包穿刺引流后好转(0.10%)。术后心包积液102例(2.61%),其中8例为少中量-中量心包积液,术后随访无明显变化或有所增多,患者血流动力学稳定,予随诊观察;94例为微量-少量心包积液,随诊观察积液量未见增加。术后残余分流167例(4.27%),其中多发房间隔缺损共102例;另外残余分流束宽度大于等于5 mm共17例,残余分流束小于5 mm或少量分流共150例,复查后分流均减少或消失。结论:房间隔缺损封堵术相关严重并发症包括封堵器脱落、心脏穿孔/磨蚀,发生率极低但危害大,常见并发症包括心包积液和残余分流,发生率低且预后好,超声心动图在及时诊断并发症和随访观察方面起到了不可替代的作用。Objectives:To determine the value of echocardiography in diagnosing postoperative complications of secundum atrial septal defect post transcatheter or transthoracic occlusion.Methods:3910 patients with secundum atrial septal defect,treated by transcatheter or transthoracic occlusion in our hospital from July 2009 to July 2018,were included.All patients underwent transthoracic echocardiography(TTE)or transesophageal echocardiography(TEE)for screening indications.The operation was performed under TTE or TEE guidance.After the operation,TTE was repeated to evaluate the occluder position and related complications.Results:There were 8 device dislocation(0.20%)and were treated with emergency surgery.There were 8 cardiac rupture/erosion,including one case of aortic sinus-right atrium shunt(0.03%),which was successfully treated with transcatheter occlusion;2 cases of anterior mitral valve perforation(0.05%),patients remained stable during the 7 years follow up without special treatment;5 cases of cardiac perforation or atrial wall injury(0.13%),one patient dead(0.03%),and 4 patients recovered after pericardium drainage(0.10%).Postoperative pericardial effusion was diagnosed in 102 patients(2.61%).8 cases had small to moderate pericardial effusion with stable hemodynamics,patients were stable during the follow-up.94 cases had trivial to mild pericardial effusion,the amount of effusion did not increase during the follow-up.There were 167 cases(4.27%)with residual shunt post operation,including 102 cases with multiple atrial septal defects,17 cases with residual shunt width greater than or equal to 5 mm,and 150 cases with residual shunt less than 5 mm.The residual shunt reduced or disappeared during the follow up.Conclusions:Serious complications associated with atrial septal defect closure include occluder dislocation,cardiac perforation/erosion,incidence of above complications is very low but sometimes is fatal.Common complications include pericardial effusion and residual shunt,incidence is low and the prognosis is good.

关 键 词：房间隔缺损封堵术 超声心动图 封堵器脱落 心脏磨蚀 心包积液 残余分流 

分 类 号：R54[医药卫生—心血管疾病]