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目的 介绍一种经心表超声引导外科微创封堵小儿室间隔缺损的新技术.方法 自2011年5月至2014年4月,使用心表超声引导对41例室间隔缺损(VSD)患儿施行外科微创封堵.年龄5个月至6岁,平均(15.1±18.5)个月,体质量5 ～26(10.78 ±6.87)kg;VSD直径3～8.5(5.2±1.13)mm.所有病例采用胸骨下段小切口,置入封堵器闭合VSD.术中使用心表超声监测封堵过程,引导封堵器的放置,术后即刻评价疗效.结果 38例在心表心动图监测引导下置入封堵器获得成功,2例因导引钢丝未通过室缺口而失败,另1例因封堵器固定不牢,术后2d发生脱落.术后有3例封堵器边缘仍存在少量残余分流;半年后复查2例消失,另1例因封堵器移位仍有少量残余分流,全组未发生房室传导阻滞,无主动脉瓣返流.结论 心表超声引导婴幼儿微创VSD封堵,操作简捷有效,可代替食道超声(TEE)单独引导微创外科封堵术的开展.“,”Objective To introduce a new technique:minimally invasive transthoracic closure of ventricular septal defects (VSD) without cardiopulmonary bypass (CPB) under guidance of transepicardial echocardiography (TECE).Methods A total of 41 patients with VSD,5 months to 6 years,averaging (15.1 ± 18.5) months,underwent transthoracic device closure.The weight of these patients ranged from 5 to 26.0 kg with an average weight of (10.78 ± 6.87) kg.The diameter of their VSD ranged from 3 to 8.5 mm with an average of (5.2 ± 1.13) mm.After small median sternotomy incision,an appropriately sized VSD occluder was inserted into the left ventricle via VSD,then the occluder was released and the VSD was closed.TECE was used to monitor the whole procedure to guide the device positioning and evaluate the cursive effect instantly after operation.Results The procedure was successful in 38 patients.Three cases failed,including two cases whose guiding wire could not pass through VSD and one case whose occluder could not fix well.Three patients had tiny residual shunt after operation,two vanished during the follow-up period,and one case still had small amount residual shunt because of the occluders shifting.In 6 to 36 months follow-up,neither complete atrioventricular heart block nor aortic insufficiency was found in any patient.Conclusions The transthoracic closure of ventricular septal defects without cardiopulmonary bypass under guidance of transepicardial echocardiography is easy,safe,and efficient.