实时三维经食管超声心动图在房间隔缺损封堵术中应用  

作　　者：倪成香 蔡洁[1] 胡国梁[1] 范庆浩[1] 范霜月 

机构地区：[1]浙江省金华市人民医院,321000

出　　处：《浙江临床医学》2024年第6期906-908,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨实时三维经食管超声心动图(RT-3D-TEE)在经皮房间隔缺损(ASD)封堵术中的应用价值。方法对38例ASD患者,分别行经二维经胸超声心动图(2D-TTE)及RT-3D-TEE检查,评估ASD形态,测量ASD最大径、各残端长度,RT-3D-TEE同时测量房间隔缺损面积,分析缺损最大径、面积与封堵器大小的相关性。根据测量结果选择封堵器大小,术中应用RT-3D-TEE监测引导封堵器的输送和释放。术后即刻评估封堵疗效并于术后3个月、6个月复查。结果下腔静脉侧残缘、主动脉侧残缘参数差异无统计学意义(P>0.05);RT-3D-TEE检测的上腔静脉残缘长度大于2D-TTE(P<0.05);2D-TTE、RT-3D-TEE测量的ASD最大径、RT-3D-TEE的面积测值与封堵器大小存在相关性(r=0.891,0.926,0.976,P<0.05),其中RT-3D-TEE测量面积与封堵器大小相关性最高。其中36例患者在RT-3D-TEE准确引导监测下,成功实施经皮房间隔缺损封堵术,术后3个月、6个月随访疗效佳,未见并发症。结论RT-3D-TEE在ASD封堵术前直观清晰显示ASD大小、形态及各残缘情况,为封堵器的选择提供可靠的参考,同时能安全有效引导封堵术,术后随访疗效佳,具有重要的临床应用价值。Objective To evaluate the value of real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in percutaneous transcatheter closure of atrial septal defect(ASD)and its follow-up.Methods 38 patients with ASD were examined by two-dimensional transthoracic echocardiography(2D-TTE)and RT-3D-TEE.The shape of ASD was evaluated,the maximum diameter and stump length of ASD were measured,and the area of atrial septal defect was measured by RT-3D-TEE.The correlation between the maximum diameter and area of defect and the size of occluder was analyzed,and the size of occluder was selected according to the results.RT-3D-TEE was used to monitor and guide the delivery and release of the occluder during the operation.The occlusion effect was evaluated immediately after operation and reexamined at 3 and 6 months after operation.Results There was no significant difference in the parameters of residual margin of inferior vena cava and aortic side,but the length of residual margin of superior vena cava detected by RT-3D-TEE was longer than that of 2D-TTE.There was a high correlation between the maximum diameter of ASD and the area of RT-3D-TEE measured by 2D-TTE and RT-3D-TEE and the size of occluder(r=0.891,0.926,0.976,P<0.05),and the correlation between the area measured by RT-3D-TEE and the size of occluder was the highest.Percutaneous transcatheter closure of atrial septal defect was successfully performed in 36 patients under the accurate guidance and monitoring of RT-3D-TEE.The effect of transcatheter closure was good immediately,3 months and 6 months after operation,and no complications were found.Conclusion RT-3D-TEE can directly and clearly display the size,shape and residual margin of ASD before ASD occlusion,which provides reliable reference data for the selection of occluder,and can guide occlusion safely and effectively.The follow-up effect is good and has important clinical application value.

关 键 词：实时三维经食管超声心动图 房间隔缺损 封堵术 

分 类 号：R654.2[医药卫生—外科学]