经食管超声心动图引导经胸微小切口封堵主动脉窦瘤破裂的可行性

目的 探讨经食管超声心动图（TEE）引导经胸微小切口封堵主动脉窦瘤破裂（RASA）的可行性。方法 回顾性分析30例接受TEE引导经胸微小切口封堵治疗的RASA患者的资料。对右冠状动脉窦瘤破裂者，准确测量破口与冠状动脉开口之间的距离，术中以TEE准确引导导丝及鞘管顺利进入窦瘤破口，术后仔细评估封堵伞位置、稳定性及对瓣膜的影响。对右冠窦瘤破裂患者，确保封堵器未遮挡冠状动脉开口。结果 30例RASA患者中，TEE引导下成功封堵20例，其中右冠窦瘤破裂10例（破入右心室7例、破入右心房3例）；无冠窦瘤破裂10例（破入右心房8例、破入右心室2例）。封堵成功患者各项生命体征平稳，心腔结构未发生明显改变，心功能正常。术后多次复查，封堵器位置正常，主动脉瓣启闭运动正常，未见狭窄及反流信号，也未检测到残余分流。结论 TEE可较为准确地诊断RASA，并引导术者准确放置封堵器；单纯TEE引导下经胸微小切口封堵RASA是一种可行的方法。

Feasibility of transesophageal echocardiography guided transthoracic incision closure of aortic sinus aneurysm rupture

Objective To explore the feasibility of transesophageal echocardiography (TEE) guided transthoracic incision closure of aortic sinus aneurysm rupture (RASA). Methods Data of 30 patients with RASA underwent TEE guided transthoracic incision closure of RASA were retrospectively analyzed. The distance between the coronary artery ostium and crevasse was measured in right coronary sinus aneurysm rupture patients. During the operation, the guide wire and sheath pipe were guided accurately into rupture mouth of aortic sinus aneurysm with TEE. After the operation, the position of closure and the function of aortic valves were checked carefully, while in right coronary sinus aneurysm rupture patients, coronary ostium should not be occluded by the occluder. Results Totally 20 of 30 patients accepted interventional treatment successfully. Right coronary sinus aneurysm rupture was found in 10 patients, including 7 with rupture developing into right ventricle and 3 with rupture into right atrium. Posterior coronary sinus tumor rupture was found in 10 patients, including 8 with rupture developing into right atrium and 3 with rupture into right ventricle. Patients who received intervention treatment successfully had stable vital signs, and no obvious changes of heart cavity structure and cardiac function was found. Postoperative multiple reexaminations showed all patients had normal closure position, aortic valve opening and closing movement was normal. No stenosis, reflux signal nor residual shunt were found. Conclusion RASA can be diagnosed accurately with TEE, and the occluder can be placed guided by TEE. TEE guided transthoracic incision closure of RASA is a feasible method.