超声心动图在外科微创封堵治疗继发孔房间隔缺损中的应用研究

摘要

Objective:To discuss the preoperative,intraoperative,and postoperative application of echocardiography in mini-invasive surgical device closure of secundum atrial septal defects,including those special and difficultly-occluded defects.Methods:We performed mini-invasive surgical device closure of secundum atrial septal defcts on 287 patients.Before the surgery,transthoracic echocardiography was applied for screening;during the surgery we reassessed the sizes of the defects and their remaining margins,designated the suitable occluders,and guided the placement of the occhiders by multiplane transesophageal echocardiography.The patients were postoperatively followed up at regular intervals by multiplane transesophageal echocardiography (MTEE) which was employed to assess the therapeutic efficacy.Results:Out of the 287 atrial septal defects,276 (96.17％) were successfully closed.There were 37 porous defects and 23 cases with short posterior-inferior margin of defects.Follow-ups at intervals showed the occluders stayed firmly and echoed clearly.No notable residual shunt or valve regurgitation was observed.Conclusion:Echocardiography plays a vital and reliable role in mini-invasive surgical device closure of secundum atrial septal defects,especially those special and diffficultly-occluded defects.%目的:探讨超声心动图在外科微创封堵治疗继发孔房间隔缺损,尤其是特殊难堵类型缺损的术前、术中及术后中的临床应用价值.方法:外科微创封堵治疗继发孔房间隔缺损患者287例,术前行经胸超声心动图筛选合适病例,术中行经食管超声心动图再次准确评估选定封堵器型号,引导封堵器正确放置并评估封堵效果,术后行经胸超声心动图定期随访评估近中期疗效.结果:287例房间隔缺损中276例封堵成功,成功率96.17％,其中多孔型缺损37例,后下缘短残边者23例.随访过程中示封堵器位置固定满意,无轻量以上残余分流及瓣膜反流,无严重传导阻滞发生.结论:超声心动图对外科微创封堵术治疗继发孔房间隔缺损,尤其是特殊难堵类型缺损有着重要且可靠的作用.