超声心动图在多发房间隔缺损封堵术中的应用

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目的:研究超声心动图在多发房间隔缺损(ASD)封堵术中的应用价值。  方法:应用经胸超声心动图(TTE)及经食管超声心动图(TEE)筛选多发继发孔型ASD患者,在X线及TTE观测下行经皮ASD封堵手术,术后24小时、1个月、3个月、半年行TTE及心电图检查、X线胸片评价疗效。共筛查出42例多发ASD患者,其中38例为双孔ASD患者,3例为中央型筛孔型ASD,1例3孔ASD,男17例,女25例,年龄3~52岁,平均年龄约(32.6±13.4)岁。  结果:采用心尖四腔心切面、胸骨旁大动脉短轴切面及剑下双房心切面测量ASD的大小及间隔距离,大孔上下径9~27 mm[平均(20.7±6.1)mm],前后径8~23 mm[平均(16.9±5.7)mm],小孔上下径3~12 mm[平均(6.8±3.6) mm],二者相距4~18 mm[平均(7.9±2.6)mm]。4例双孔间距超过7 mm的双孔ASD患者(间距为8.7 mm)应用两个封堵器分别封堵两个孔,术后无分流。其他38例采用一个封堵器封堵,封堵器采用14~36 mm进口或国产Amplatzer封堵器,平均约(25.1±6.4)mm,比超声测量值大约(6.9±1.7)mm,均为封堵大孔,手术封堵成功率100%,术后残余分流17例,残余分流率约占40.5%。术后随访6~36个月,平均18.7个月,随访三个月后仅有11例有少量残余分流,占26.2%。  结论:超声心动图对病例的选择、封堵器的型号选择、术中监测、术后疗效评价等方面均有重要的作用。“,”Objective: To evaluate the effect of echocardiography for occluding the multiple seconded atria1 septal defects ( MASD) in relevant patients. Methods: A total of 42 MASD patients were selected by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The transcatheter closure was monitored by TTE and X-ray, the effect of treatment was evaluated by TTE, ECG and chest X-ray at 24 hours and 1, 3, 6 months after the procedure. There were 38 patients with 2 defects, 3 with many central small defects and 1 with 3 defects. The patients included 17 male and 25 female with the mean age of (32.6 ± 13.4) years. Results: The size and distance of the defects were measured with 4 cardiac chambers cross sectional study. The mean diameter of bigger defect from up to down was (9-27) mm, with the mean of (20.7 ± 6.1) mm, from front to back was (8-23) mm, with the mean of (16.9 ± 5.7) mm;the mean diameter of small defect from up to down was (3-12) mm, with the mean of (6.8 ± 3.6) mm. The length of the defect interva1 was (4-18) mm, with the mean of (7.9 ± 2.6) mm. There were 4 patients with 2 defect interval at 8.7 mm who received 2 occluders without post-operative lfow shunt. The rest 38 patients received 1 Amplatzer occluder which was (14-36) mm with the mean of (25.1 ± 6.4) mm which was (6.9 ± 1.7) mm larger than echocardiographic prediction. The success rate of implantation was 100%. There were 17 (40.5%) patients with post-operative lfow shunt. The patients were followed-up for (6-36) months, with the mean of 18.7 months, there were 11 (26.2%) patients with small amount of lfow shunt at 3 months after the operation. Conclusion: Echocardiography is important for choosing the type and size of occluder devices, in-operative monitoring and post-operative effect evaluation for treating the ASD patients.
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