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目的:旨在评价经食管超声心动图(TEE)在行Amplatzer间隔封堵器(ASO)经导管修补继发孔型房间隔缺损术中的应用价值。方法:选择继发孔型房间隔缺损患者62例,年龄10～55岁。超声检查用于①术前筛选;②术中采用经食管超声心动图进行封堵术中引导和监测;③术后复查,观察封堵器的位置、周围结构的关系、有无残余分流等。结果:本组患者采用TTE、TEE和球囊X线影像(房间隔缺损最大伸展径)3种测量方法。其结果显示:TTE测值(19.1±5.8)mm与术中球囊测值(25.1±6.4)mm之间存在显著性统计学差异(P<0.001);TEE测值(23.5±6.2)mm与术中球囊测值之间不存在统计学差异(P>0.05)。62例患者均在TEE引导和监测下成功地完成ASD封堵。CDFI显示其中61例,封堵器释放后即无左向右分流;1例上腔静脉型ASD患者,靠上腔静脉端有2mm残余分流。术后即刻、24h、1个月、3个月、6个月、1年行TTE或TEE检查,62例患者封堵器位置稳定、无移位,未影响周围瓣膜的功能及静脉的回流。1例上腔静脉型ASD患者,1年后靠上腔静脉端仍有2mm的残余分流;余61例无左向右分流。结论:在经导管Amplatzer间隔封堵器修补ASD术中,TEE可准确地引导和监测封堵器的放置,评估手术疗效。同时,TEE在ASD封堵术中的应用是安全、可行、患者完全可以耐受的。
Objective: To evaluate the value of transesophageal echocardiography (TEE) in transcatheter repair of secundum atrial septal defect with Amplatzer septal occluder (ASO). Methods: Sixty-two cases of secondary atrial septal defect were selected, aged from 10 to 55 years. Ultrasonography for ① preoperative screening; ② intraoperative transesophageal echocardiography for closure and guidance and monitoring; ③ postoperative review to observe the occluder position, the relationship between the surrounding structure, with or without residual shunt. Results: Three kinds of measurement methods of TTE, TEE and balloon X-ray (maximum extension of atrial septal defect) were used in this study. The results showed that there was a significant statistical difference (P <0.001) between TTE (19.1 ± 5.8) mm and intraoperative balloon measurement (25.1 ± 6.4) mm; TEE was (23.5 ± 6.2) mm and There was no significant difference between intraoperative balloon measurements (P> 0.05). Sixty-two patients successfully completed ASD occlusion under TEE guidance and monitoring. CDFI showed 61 cases without left-to-right shunt after the occluder was released. In 1 case of superior vena cava ASD, there was 2 mm residual shunt on the superior vena cava. TTE or TEE was performed immediately after operation, 24 h, 1 month, 3 months, 6 months and 1 year. The occluder position was stable and no displacement was observed in 62 patients. The function of the surrounding valves and the venous return were not affected. In 1 case of superior vena cava ASD, 2 mm of residual shunt were still present in the superior vena cava after 1 year; 61 cases had no left-to-right shunt. CONCLUSIONS: TEE can accurately guide and monitor placement of occluders during the ASD procedure for catheter-assisted amplatzer septal occluder closure to assess surgical outcomes. In the meantime, the application of TEE in ASD occlusion is safe and feasible and the patient is completely tolerable.