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目的探讨经食道超声心动图(transesophageal echocardiography,TEE)在经胸微创外科室间隔缺损(ventricular septal defect,VSD)封堵术中的作用。方法对经胸超声心动图(transthoracic echocardiography,TTE)筛选的47例适合封堵的室间隔缺损(VSD)患者施行外科微创封堵术。术前TEE再次根据VSD位置、大小、形态选择封堵器的类型、型号;术中全程监测引导封堵过程;术后即时评价手术效果;术后1周内、1个月、2个月、6个月、1年TTE随访,观察术前、术中、术后患者残余分流、瓣膜反流以及心律失常等并发症。结果47例VSD患者在TEE引导下行经胸微创封堵治疗,43例封堵成功,其中采用等边封堵器27例,偏心封堵器15例,肌部封堵器1例;其他4例中,1例因残余分流较大,1例因对主动脉瓣、三尖瓣影响较大,1例患者放置封堵器效果不满意,出现封堵器移位,经调整封堵器的类型、型号后效果仍欠佳,然后改为体外循环下心内直视VSD补片修补术,最后1例封堵效果不满意,因患儿有地中海贫血且年龄小,行体外循环下心内直视VSD补片修补术风险太大,告知家属,家属放弃治疗。结论超声心动图在经胸微创外科VSD封堵术中起重要作用,术前筛选病例、术中全程监测引导封堵器的释放,术中及术后评价其效果等都需要TEE及TTE。
Objective To investigate the effect of transesophageal echocardiography (TEE) in the closure of minimally invasive surgical ventricular septal defect (VSD). Methods Seventy-seven patients with VSD who underwent transthoracic echocardiography (TTE) were treated with surgical minimally invasive sealing. TEE again according to the location of the VSD, size, shape of the occluder type, type; intraoperative monitoring guide the closure process; postoperative immediate evaluation of the effect of surgery; 1 week after surgery, 1 month, 2 months, Six-month, one-year follow-up of TTE was performed to observe the complications such as residual shunt, valve regurgitation and arrhythmia in preoperative, intraoperative and postoperative patients. Results 47 cases of VSD underwent minimally invasive transthoracic closure therapy guided by TEE, and 43 cases were successfully blocked, including 27 cases of equilateral occluder, 15 cases of eccentric occluder and 1 case of muscular occluder. Other 4 In one case, due to a large residual shunt, a case of aortic valve, tricuspid valve greater impact in 1 case was not satisfied with the placement of the occluder, the occluder shift appears occluder, Type, type, the effect is still not good, and then under the cardiopulmonary bypass with open-heart VSD patch repair, the last case of sealing effect is not satisfied, because children with thalassemia and age, undergoing cardiopulmonary bypass under direct vision VSD patch repair risk is too large, inform the families, relatives to give up treatment. Conclusion Echocardiography plays an important role in the closure of traumatic minimally invasive surgical VSD in transthoracic surgery. Preoperative screening cases, intraoperative monitoring and guidance of the occlusion device release, intraoperative and postoperative evaluation of the effectiveness of TEE and TTE are needed.