经胸超声心动图代替经食道超声心动图引导房间隔缺损封堵术  

Transcatheter Closure of Secundum Atrial Septal Defect Under Transthoracic Echocardiography Instead of Transesophageal Echocardiography

作　　者：温朝阳[1] 李越[1] 王广义[2] 王寺峰 

机构地区：[1]解放军总医院超声科,北京市100853 [2]解放军总医院心内科,北京市100853

出　　处：《中国超声医学杂志》2003年第6期427-430,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 :研究经胸超声心动图 ( TTE)代替经食道超声心动图 ( TEE)引导 Amplatzer房间隔缺损( ASD)封堵器经导管治疗 ASD。方法 :6 4例有外科手术适应症的 孔型 ASD患者行 TTE检查 ,如果可清楚观察 ASD及其周边残存房间隔、周围功能性结构状况 ,能明确判断适合封堵即可选择 TTE引导封堵。否则进行 TEE检查 ,符合封堵条件者采用 TEE引导。 TTE引导时 ,心尖四腔切面观察封堵器呈规整‘二’形 ,大动脉短轴切面呈规整‘二 ’形或‘Y’形 ,剑下两房切面呈规整‘二 ’字形 ;TEE引导时 ,观察封堵器腰部卡于房缺处、两伞平行地夹于房间隔两侧。同时超声观察到封堵器位置稳定 ,无残余分流 ,不影响周围结构功能 ,封堵成功。结果 :5例封堵失败 ,其中 TEE 3例 TTE 2例。 TEE成功引导 2 6例封堵器置入 ,TTE 33例。 4例患者封堵 2次 ,第 2次住院封堵 3例成功 ,TTE和 TEE各引导 2例。 TTE随访 ,术后 2 4小时每组各有 1例患者少量残余分流(分流束宽≤ 2 mm) ,3个月时 1例 TTE引导的患者尚有少量残余分流。结论 :大部分适合封堵的 孔型 ASD患者 ,TTE能清楚观察 ASD及其周边残存房间隔状况、ASD边缘至周围功能性结构距离 ,可以代替 TEE筛选患者、引导 Amplatzer ASD封堵器置入.Objective:To study transcatheter closure of secundum atrial septal defects(ASD) with the Amplatzer atrial septal defect occlusion devices under transthoracic echocardiography(TTE) instead of transesophageal echocardiography(TEE).Methods:Sixty four patients with secundum ASD waiting for surgical treatment underwent TTE for transcatheter closure.If the rudimentary atrial septum and the surrounding functional structures of ASD could be observed distinctly under TTE and the patient indicated the conditions of transcatheter closure, TTE was chosen for mornitoring during the operation.Otherwise,the patient indicated for operation was examined by TEE which was chosen for mornitoring.If the device looked like nice '' in apical and parasternal four chamber view, nice ' or 'Y' in parasternal aortic root axis view, and nice in subcostal two atrial view when it was guided by TTE, or its position was optimal when it was guided by TEE, and there was not residual shunt, it was successful.Results:Treatments failed in five patients.Three of them were guided by TEE and two by TTE.Twenty-six patients were treated successfully under TEE guidance, and thirty three patients under TTE.Four patients were treated twice and the operations succeeded in three patients secondly, two of them were guided by TEE, and the others by TTE. Fellow-up study:Two patients had small residual shunts 24 hour later, and just one patient had small residual shunt 3 months later.Conclusions:In most patients with secundum ASD who were suitable for transcatheter closure with the Amplatzer atrial septal defect occlusion devices, TTE can disfinctly observe the ASD,the rudimentary atrial septum and the distances from the margins of the ASD to the surrounding functional structures,it can be used to select the patients and guide the operations instead of TEE.

关 键 词：经胸超声心动图 经食道超声心动图 房间隔缺损 封堵术 

分 类 号：R540.45[医药卫生—心血管疾病]