目的:本文报告1998年10月~2005年3月应用超声导引介入治疗11例多发性ASD体会。方法:11例中男2例,女9例。年龄4~60(26.1±4.2)岁。11例中8例2处缺损,2例3处缺损,1例4处缺损。2例合并房间隔膨出瘤,1例合并心房纤颤和心包积液。使用仪器日本东芝6000型和美国惠普1500型彩色多普勒血流显像仪和食道超声(TEE),探头频率为2.5MHz和5MHz。术前用体表超声TTE诊断,必要时配合TEE诊断,术中均用TEE配合,术后第2天及随诊均应用TTE。TTE常选择切面为胸骨旁、心尖及剑突下四腔心切面,剑突下两房心切面及大动脉短轴切面。TEE常选择切面为房间隔长轴切面,上、下腔静脉长轴切面,大动脉短轴切面及四腔心切面。结果:应用TEE和TTE选择11例多发性ASD介入治疗,其中9例应用一个闭合器功闭合,闭合器型号12~40mm,2例应用两个闭合器闭合缺损,2例超声证实术后残余分流。无其它并发症。结论:多发性ASD介入治疗,必用TEE监测,确定ASD数目、直径和间距,尽量用1个闭合器闭合多处缺损。
Abstract
Objective: This study reports our clinical experience of interventional treatment of multi-fenestrated atrial septal defect(ASD) under echocardiography. Methods: From December 1998 to March 2005, 11 patients, 2 males, 9 females, with mean age of 26.1±4.2 years(ranged from 4 to 60 years old), underwent percutaneous closure of multi-fenestrated ASD. Out of the 11 patients, 8 had two defects, 2 had three defects, 1 had four defects. Two of the 11 patients associated with atrial septal aneurysm, one with atrial fibrillation and hydropericardium. The frequency of detecting probe used was 2.5MHz and 5.0MHz respectively. Diagnosis was determined with transthoracic or transesophageal echocardiography before procedure, procedure was performed under support of transesophageal echocardiography. Transthoracic echocardiography(TTE) was used on the second day after the procedure and during follow-up. TTE mainly observed in parasternal, cardiac apical, inferior xiphoid process four chamber view, and inferior xiphoid process couple atrium, great artery minor axial views, and TEE mainly reviewed in atrial septal long axis, superior vena cava long axis, inferior vena cava, great artery minor axis, four chamber view. Results: Nine of the 11 patients were successfully treated with single occluder(device size ranged from 12 to 40mm), two were implanted with two devices for effective closure of all defects(occluder diameter 18 and 8mm). During follow-up, residual shunting was observed in two of the 11 patients, and no other complications were noted. Conclusions: Multi-fenestrated ASDs should be closed under transesophageal echocardiographic guidance to determine number, diameter and distance of ASDs. We should try our best to close multi-fenestrated ASDs with one device.
关键词
房间隔缺损 /
超声检查 /
介入性
Key words
heart septal defects /
atrial /
ultrasonography /
interventional
中图分类号：
R541.1
R540.45
R815
