食道超声心动图评估边缘不足房间隔缺损经胸小切口与经颈内静脉封堵术的有效性和稳定性  

Assessment of the effectiveness and stability of atrial septal defect closure using a mini thoracotomy and transvenous occlusion via the internal jugular vein guided by transesophageal echocardiography

作　　者：陈玲玲[1,2] 左明良 谭今[3] 尹立雪 CHEN Lingling;ZUO Mingliang;TAN Jin;YIN Lixue(Department of Cardiovascular Ultrasound and Non-invasive Cardiology,Sichuan Academy of Medical Sciences&Sichuan Pro-vincial People's Hospital,Chengdu 610072,China;Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sich-uan Province,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Cardiothoracic Surgery,Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院(电子科技大学附属医院)心血管超声及心功能科,成都610072 [2]超声心脏电生理学与生物力学四川省重点实验室,四川省心血管病临床医学研究中心(国家心血管疾病临床医学研究中心四川分中心),成都610072 [3]四川省医学科学院·四川省人民医院(电子科技大学附属医院)心脏外科,成都610072

出　　处：《西南医科大学学报》2023年第4期336-341,共6页Journal of Southwest Medical University

基　　金：电子科技大学中央高校基金项目(ZYGX2020ZB038)。

摘　　要：目的 探讨经食道超声心动图(transesophageal echocardiography,TEE)评估边缘不足房间隔缺损(atrial septal defect,ASD)经胸小切口与经颈内静脉封堵术的有效性和稳定性。方法 选取四川省人民医院心脏外科收治的边缘不足ASD患者72例,根据手术方式不同分为经胸小切口封堵组26例和经颈内静脉封堵组46例。所有患者均在TEE引导下进行封堵治疗。术前TEE筛选合适病例;麻醉状态下TEE再次评估ASD缺损状态(即ASD最大径和缺损边缘情况),选择合适型号封堵器并引导放置,封堵后即刻记录房间隔血流状态(即残余分流)和封堵器状态指标(即封堵器直径、主动脉端夹角和上腔静脉端夹角);术后3天、2周、6月及12月进行心电图和经胸超声心动图(transthoracic echocardiography, TTE)随访并记录封堵器的脱落、瓣膜损伤等封堵器相关心脏并发症。结果 (1)72例边缘不足ASD患者中69例成功置入封堵器,3例术后出现封堵器脱落并在急诊外科再次微创封堵。2例术后即刻显示有少量残余分流,1例3天后自行消失,1例因封堵器脱落再次封堵后消失。后期随访未见其他封堵器相关心脏并发症。(2)经颈内静脉封堵组封堵器主动脉端夹角、上腔静脉端夹角与ASD最大径呈正相关,主动脉端夹角与后缘残端长度呈负相关,上腔静脉端夹角与房室瓣缘残端长度呈负相关(P <0.05)。经胸小切口组封堵器主动脉端夹角、上腔静脉端夹角与ASD缺损最大径、各残端长度无明显相关(P> 0.05)。结论 TEE引导经胸小切口与经颈内静脉封堵边缘不足ASD是一种可行且有效的手术方式,TEE能准确评估术前ASD缺损状态和术后封堵器状态,封堵器主动脉端夹角可以量化封堵器骑跨大动脉端的程度,封堵器上腔静脉端夹角可以反映外科缝合加固后封堵器伞面与上腔静脉间解剖位置变化,两者可用于外科微创封堵ASD术后封堵器稳定性的量化评估。Objective Assessment of the effectiveness and stability of atrial septal defect closure using a mini thoracotomy and transvenous occlusion via the internal jugular vein guided by transesophageal echocardiography.Methods A total of 72 cases of ostium secundum ASD patients with deficient rim,who underwent mini-invasive closure under the guidance of TEE at the Department of Car⁃diac Surgery in Sichuan Provincial People′s Hospital were enrolled.The subjects were classified into two groups by the different surgi⁃cal closure paths:26 cases in the mini-incision transthoracic device closure(transthoracic group)and 46 cases in the trans-jugular vein device closure(trans-jugular vein group).TEE was used to screen suitable cases before operation.Under anesthesia,TEE reevaluated the ASD defect status,including the maximum diameter and defect edge of ASD,selected the appropriate type of occluder and guided the monitoring placement.Immediately after occlusion,the blood flow status(i.e.residual shunt)of atrial septum and the status index of occluder(i.e.occluder diameter,occluder angles of the aortic edge and the SVC edge angle)were recorded.ECG and TTE were followed up 3 days,2 weeks,6 months and 12 months after operation to record related cardiac complications(i.e.occluder disloca⁃tion,valve injury).Results①Among 72 ASD patients with insufficient rim,69 cases were successfully closed,and 3 cases underwent second minimally invasive closure operation because of occluder dislocation.Small residual shunts were found in 2 cases after operation,1 case disappeared by TEE observation 3 days after the procedure,and 1 case disappeared after re-occlusion due to the dislocation of occluder.No cardiovascular complication occurred during the later follow-up.②The occluder angles of the aortic edge and the superior vena cava(SVC)edge in the trans-jugular vein group were positively correlated with the maximal defect diameter.The occluder angles of the aortic edge were negatively correlated with the posterior rim,and the occluder a

关 键 词：房间隔缺损 经食道超声心动图 微创封堵治疗 封堵器 

分 类 号：R445.1[医药卫生—影像医学与核医学]