超声心动图在小儿及疑难房间隔缺损介入治疗病例中的应用探讨（附126例报告）

目的：评价超声心动图在继发孔型房间隔缺损（ASD）介入封堵治疗中的应用价值。方法2008年9月～2012年12月，126例继发型房间隔缺损患儿，其中男38例，女88例，年龄2.3～17.0岁，平均6.7±3.5岁。单一ASD 117例，多发性ASD 9例。其中1例合并肺动脉瓣狭窄（PS），3例合并房间隔膨出瘤（ASA）。126例患儿均行经胸超声心动图（TTE）检查，少数肥胖患儿行经食管超声心动图（TEE）检查，根据检查结果选择封堵器型号，术中用TTE或TEE引导封堵器释放。术后采用TTE随访。结果124例患儿其中含边缘不足的7例疑难病例，应用进口或国产封堵器均成功封堵，成功率98.4%。经TTE或TEE测量ASD最大直径3.3～26.0mm，平均16.5±3.4mm。所选封堵器直径6.0～30.0mm，平均19.0±4.0mm。7例多发性ASD选用1枚封堵器，1例选用2枚封堵器获得成功。1例合并PS者同时完成介入治疗。124例患儿术后TTE随访发现，2例存在微量残余分流，并于1个月后自愈。结论超声心动图在小儿ASD介入适应症选择及介入过程中引导、术后随访中的作用仍不可替代。

Application of Echocardiography in Transcatheter Occlusion of 126 ASD in Pediatric Patients and Transcatheter Closure of ASD Associated with Deficient Rims

Objective To evaluate the clinical value of tanscatheter closure of atrial septal defect（ASD） with occlusion device in pediatric patients by the guiding of echocardiology.Methods In 126 patients with ASD,38 males,88 females,the age ranged from 2.3 to 17.0 years（mean 6.7±3.5 years）.9 patients were multiple ASD,1 case associated with pulmonary stenosis（PS） and 3 cases atrial septal aneurysm（ASA）.126 ASD patients underwent transthoracic echocardiography（TTE） or transesophageal echocardiography（TEE） before the interventional therapy.The occluder sizes were decided by ASD sizes according to the results of TTE or TEE.TTE was used in all patients for postoperative follow up.Results 124 patients including 7 cases of edge-insufifciency ASD or large ASD had been occluded successfully.The success rate was 98.4%.The diameters measure by TTE or TEE were 3.3 to 26.0mm（mean 16.5±3.4mm）.The diameters of devices were 6.0 to 30.0mm（mean 19.0±4.0mm）.Among them,7 cases with multiple ASDs have been occluded using one device and one case with multiple ASDs using two devices.One case associated with PS was treated by balloon dilatation simultaneously.Trace residual shunt was found in two cases post-occlusion,but the shunt vanished one month later.Conclusion Echocardiography have high value in selecting patients and guiding in transcatheter occlusion of ASD and postoperative follow-up in pediatric patients with ASD.