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目的探讨经胸超声心动图(TTE)和经食管超声心动图(TEE)在小儿及成人继发孔房间隔缺损(ASD)封堵术前筛查中的应用特点及价值。方法对行介入封堵(A组,136例)及外科微创封堵(B组,63例)治疗的单纯继发孔ASD患者的超声心动图资料及手术结果进行回顾性分析。依据术前是否行TEE检查将研究对象分为4组,A1及B1组患者(>15岁)术前经TTE及TEE筛查,A2及B2组患者(≤15岁)术前仅经TTE筛查。A组患者术中行TTE监护,B组患者术中行TEE监护。结果 ASD缺损径的TTE与TEE测值比较,在A1及B1组差异有统计学意义(P<0.01),在B2组差异无统计学意义(P>0.05);A1、B1、B2组内比较最大缺损径TTE测值与封堵器大小间相关性均低于TEE,组间比较A2及B2组最大缺损径TTE测值与封堵器大小间相关性分别较A1及B1组高。结论 TTE对于低龄小儿患者,可代替TEE成为封堵术前筛选病例的主要方法;TEE对ASD的大小评估优于TTE,在成人患者术前应尽量行TEE作为TTE的补充。
Objective To investigate the characteristics and value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in preoperative screening of secondary atrial septal defects (ASD) in children and adults. Methods The echocardiographic data and surgical results of patients with simple ASD treated with interventional occlusion (group A, 136 cases) and surgical minimally invasive occlusion (group B, 63 cases) were retrospectively analyzed. The subjects were divided into 4 groups according to whether the preoperative TEE examination was performed or not. Patients in group A1 and B1 (> 15 years old) were screened by TTE and TEE before surgery. Patients in groups A2 and B2 (≤15 years old) check. Patients in group A underwent TTE monitoring during operation and patients in group B underwent TEE monitoring. Results There was significant difference between TTE and TEE in ASD defect diameter (P <0.01), but there was no significant difference in B2 group (P> 0.05). In A1, B1 and B2 group, the difference between TTE and TEE was statistically significant The correlations between the maximum defect diameter TTE and occluder size were lower than those of TEE. The correlations between the maximum defect size TTE and the size of the occluder in group A2 and group B2 were higher than those in group A1 and B1, respectively. Conclusions TTE can replace TEE as a primary method of preoperative closure in younger pediatric patients. TEE is superior to TTE in evaluating the size of ASD. TEE should be supplemented before surgery in adults.