经食管超声心动图监测偏心型封堵器经胸微创室间隔缺损封堵术的应用

摘要

PurposeTo explore the value of transesophageal echocardiography (TEE) monitoring mini-incision transthoracic occlusion of ventricular septal defect (VSD) with asymmetric ventricular defects occlude in preoperative selection of patients, intraoperative guidance monitoring and postoperative evaluation.Materials and MethodsForty-five cases of VSD undertook mini-incision transthoracic occlusion with asymmetric ventricular defects occlude were enrolled, their clinical data was analyzed retrospectively, preoperative transthoracic echocardiography (TTE) was applied for choosing appropriate cases. During surgery, TEE was employed for evaluating the VSD and in which perimembranous VSD was found in 21 cases, intracristal VSD in 15 cases and subpulmonic VSD in 9 cases, suitable eccentric type occluders were chosen, guide occluder was placed, and the occlusion effect was evaluated right after operation.ResultsThe procedures were completed successfully in 42 cases, with a successful rate of 93.3%, of which 21 cases had perimembranous VSD, 15 cases had intracristal VSD, and 6 cases had subpulmonic VSD. The diameter of the VSD ranged from 3 to 7 mm, averaging (4.5±0.7) mm, the diameter of occluders ranged from 4 to 8 mm, averaging (5.7±1.2) mm, there was a good positive correlation between size of VSD and occlude (r=0.87,P<0.05). All patients received follow-ups from 3 months to 24 months after operation, all the occluders located normally, with no more than mildly residual shunt, valve regurgitation or severe arrhythmia discovered.ConclusionMini-incision transthoracic occlusion of ventricular septal defect (VSD) with asymmetric ventricular defects occlude has high success rates, minimal injury, and lower complication rate. TEE can play a vital role by improving the success rate and safety of surgery.%目的：采用经食管超声心动图（TEE）监测偏心型封堵器经胸微创室间隔缺损（VSD）封堵术，探讨TEE在术前选择病例、术中引导监测及术后评估中的应用价值。资料与方法回顾性分析采用TEE监测偏心型封堵器经胸微创封堵VSD的45例患儿，术前行经胸超声心动图筛选合适病例。术中开胸前行TEE检查详细评估VSD，其中膜周型21例，嵴内型15例，干下型9例，选择合适的偏心型封堵器，引导封堵器放置，术后即可评估封堵效果。结果45例行封堵的患儿中，42例成功封堵，成功率为93.3%，其中膜周型21例，嵴内型15例，干下型6例。TEE测量VSD直径平均（4.5±0.7）mm（3~7 mm），术中所用封堵器直径平均（5.7±1.2）mm （4~8 mm），术中封堵器大小与术中TEE测量VSD大小呈正相关（r=0.87，P<0.05）。随访3~24个月，封堵器位置正常，无轻量以上的残余分流及瓣膜反流，无严重心律失常等并发症。结论偏心型封堵器经胸微创VSD封堵术成功率高，创伤小，并发症少，TEE对于确保手术成功和安全有重要作用。