摘要
目的报告利用超声心动图引导下经导管房间隔缺损封堵术(TCASD)治疗特殊类型房间隔缺损(ASD)的体会。方法收集ASD病例229例,经胸和(或)经食管超声心动图(TTE、TEE)行术前筛选、ASD残边评估、封堵器(ASO)型号选择和术后随访观察。结果①边缘不全型ASD141例,其中前上缘残端不全型123例,成功封堵119例(96.75%);上腔静脉残端不全型10例,均成功封堵(100%);下腔静脉残端及后壁残端不全型8例,成功封堵4例(50.00%);②巨大房缺9例,6例封堵成功(66.67%)。TEE测ASD最大径(36.30±1.90)mm(34～38mm),植入ASO大小为(39.60±2.20)mm(36～42mm);③多孔型房缺11例,其中双孔型8例,三孔型3例,均成功封堵(100%),残余分流3例(27.27%),术后12个月均消失;④合并ASA12例,其中多孔型4例,均成功封堵(100%),术后即刻残余分流2例,术后12个月随访均消失。结论TCASD治疗特殊类型ASD是安全、可行的,术前尽可能采用TEE了解ASD解剖细节是此类手术顺利成功的保证。
Objective To report the experiences of eehocardiography in transcatheter closure of atrial septal defects （TCASD） for complex atrial septal defects （ASD）. Methods Two hundred and twenty-nine patients with ASD were examined with transthoracic echocardiography （TTE） and （or） transesophageal echocardiography （TEE） for pre-operative assessment of ASD rims, selection of amplatzer septal occluder （ASO） and post-operation follow-up. Results （1）Deficient rim was detected in 141 patients, including 123 superior-anterior （SA） rim deficiency, and 119 （96.75%） of them were successfully implanted with ASO. Ten of 141 patients had deficient rim in superior vena cava and received successful operation. Eight of 141 patients had deficient posteroinferior and posterior rim and also received ASO implant. The operation was successful in 4 （50. 00%） patients of them; （2）Nine of the 229 ASD patients had large defect. Six （67.67%） of them were successfully treated. The maximum ASD diameter ranged from 34 mm to 38 mm （[36.30± 1.90]mm）. The size of implanted ASO was （39. 60±2.20）mm （36-42 mm） ; （3）Eleven of 229 ASD patients had multiple ASD, 8 of them had two defects and 3 had three defects. They were all successfully closed. Residual shunt disappeared in 3 patients （27.27%） 12 months after operation; （4）Twelve of the 229 ASD cases had ASA, and 4 of them had multiple defects. They were all successfully closed. Two patients with residual shunt were found immediately after the operation. During the 12 months follow-up, all residual shunts disappeared. Conclusion TCASD is a safe and feasible way for treating complex ASD. It is crucial to study ASD anatomical details with TEE to ensure the success of TCASD.
出处
《中国医学影像技术》
CSCD
北大核心
2009年第6期1021-1024,共4页
Chinese Journal of Medical Imaging Technology
