经食道超声心动图在成人继发孔 ASD 封堵治疗中的应用价值

摘要

Objective:To explore the application value of transesophageal echocardiography (TEE)in secondum atri-al septal defect (ASD)intervention and minimally invasive occlusion surgery in adult patients.Methods:A total of 134 cases adult patients (>15 years)with pure secondum ASD (including 91 cases undergoing interventional occlu-sion and 43 cases undergoing minimally invasive occlusion surgery),who were screened via transthoracic echocardio-graphy (TTE)and TEE from Jan 2012 to Dec 2012,were selected.Intervention group and minimally invasive sur-gery group received TTE and TEE monitoring respectively during operation.Preoperative TTE and TEE parameters and operation results were compared and analyzed.Results:The parameters of ASD diameter measured by TEE were significantly higher than those measured by TTE in two groups (P <0.01 all).Maximum defect diameter of ASD measured by TEE was significantly higher than that of measured by TTE [(19.8±5.2)mm vs.(18.7±4.9)mm], P <0.01. The correlation between maximum defect diameter measured by TTE and occluder size (intervention group r =0.926,minimally invasive surgery group r =0.215)was all lower than that of TEE (intervention group r=0.965,minimally invasive surgery group r =0.627),P <0.01 both.Conclusion:TEE is better than TTE in as-sessment of ASD size.It should be regarded as a routine preoperative screening method for adult ASD patients.It has important value in real-time monitoring,guidance and immediate evaluation of therapeutic effects during mini-mally invasive ASD occlusion surgery.%目的：探讨经食道超声心动图（TEE）在成人继发孔房间隔缺损（ASD）介入及外科微创封堵术治疗中的应用价值。方法：以2012年1月至12月间通过经胸壁超声心动图（TTE）及 TEE 筛选的行介入封堵（91例）及外科微创封堵（43例）治疗的134例成人（＞15岁）单纯继发孔 ASD 患者为研究对象，介入组患者术中行 TTE 监护，外科微创组患者术中行 TEE 监护。对术前 TTE 和 TEE 相关参数及手术结果进行对照分析。结果：两组患者ASD 缺损径的 TEE 测值均显著大于 TTE 测值（P 均＜0.01），最大缺损径的 TEE 测值均显著大于 TTE 测值[（19.8±5.2）mm 比（18.7±4.9）mm]，P ＜0.01；最大缺损径的 TTE 测值与封堵器大小间相关性（介入组 r＝0.926，外科微创组 r＝0.215）均低于 TEE （介入组 r＝0.965，外科微创组 r＝0.627），P 均＜0.01。结论：经食道超声心动图对房间隔缺损的大小评估优于经胸壁超声心动图，应作为成人房间隔缺损封堵患者术前筛查的常规检查，在外科微创封堵房间隔缺损中作为实时监测引导、即刻评价疗效具有重要价值。