三维食管超声心动图在经胸小切口房间隔缺损封堵术中的应用

摘要

Objective To explore the effect of real_time 3D transesophageal echocardiography (RT_3D TEE)guided small chest inci-sion for ASD occlusion.Methods 30 cases of ASD were preliminary screened before the operation ,ASD sizes ranged from 6mm to 32mm ,atrial septal margin was bigger than 5mm.The total lengths of atrial septum ,the largest diameter of ASD ,the length of the soft edges of atrial septal margin were measured by transthoracic echocardiography (TTE) before the operation.The data were mea-sured during the operation by RT_3D TEE and compared with those before the operation.Patients were followed_up 1 to 12 months af-ter operation.Results 30 cases with thoracic small incision closure were all successful ,without further processing accidents.In terms of the identification of total length of atrial septal and soft edge ,the TEE did better than TTE.In terms of measuring the largest diam-eter of ASD ,there were no significant differences.RT_3D TEE imaging showed stereo image of atrial septal defect. Conclusions In small chest incision for ASD occlusion ,real_time 3D transesophageal echocardiography may play a more important role in choosing ap-propriate cases ,the size of occluder ,guiding occluder release and therapeutic evaluation than TTE.With equipment of three_dimen-sional imaging ,the effect of examination is more ideal.%目的：探讨实时三维经食管超声心动图（RT_3D TEE ）在监测经胸小切口房间隔缺损（ASD ）封堵术的作用。方法初步筛查适合封堵术的ASD患者30例，缺损大小6mm～32mm ，房间隔残缘≥5mm。术前采用经胸超声心动图（TTE）重点测量房间隔总长度、房间隔缺损的最大径、房间隔残缘软边的长度；术中采用RT_3D TEE监测，并测量房间隔总长度、房间隔缺损的最大径、房间隔残缘软边的长度，与术前检查结果进行比较。术后1～12个月进行随访。结果30例经胸小切口ASD封堵术全部成功，没有出现需要进一步处理的意外。经食管超声心动图（TEE ）在识别房间隔总长度、软边长度方面均优于TTE ，两者在测量房间隔缺损最大径方面无统计学意义，RT_3D TEE成像显示房间隔缺损立体影像图。结论经胸小切口ASD封堵术中应用经食管超声心动图对于选择合适病例、封堵器型号、指导封堵过程以及疗效评价方面具有重要作用并优于经胸超声心动图，配备实时三维成像功能检查效果更理想。