经食管超声心动图引导房间隔缺损封堵治疗的研究

目的探讨经食管超声心动图引导房间隔缺损封堵术的方法。方法122例房间隔缺损患者,年龄10～65岁,男性36例,女性86例,在超声和X线共同监测引导下,用CardioSEAL和Amplatzer封堵器进行房间隔缺损封堵治疗。122例均经食管超声监测引导。结果经胸超声测定的房间隔缺损直径范围7.5～27mm,平均(16.5±4.3)mm,经食管超声测定的直径6～33mm,包括7例大于30mm,所有患者均有不同程度的右心房和右心室扩大。114例封堵治疗成功,无并发症发生。结论采用Amplatzer或CadrioSEAL封堵器,在经食管或经胸超声和X线共同监测引导下,可以安全有效地封堵治疗房间隔缺损。     

经食管超声心动图在房间隔缺损及伴心内其他疾患介入治疗中的应用

目的探讨经食管超声心动图(TEE)在房间隔缺损(ASD)及伴心内其他疾患介入治疗中的应用价值。方法采用TEE准确评价ASD的空间方位、大小和边缘状况，及其与周围心内结构的关系，并在TEE引导下对单纯性ASD、Lutembacher综合征，Triology of Fallot三联症(TOF3)、部分适合封堵的房间隔膨胀瘤并ASD、多发性ASD进行综合性介入治疗。结果31例中，30例用Amplatzer封堵器对ASD封堵成功。对伴发的二尖瓣狭窄、肺动脉瓣狭窄于ASD封堵前行瓣膜球囊扩张术；对多发性筛孔状ASD先行球囊房间隔造口术，然后选用匹配的封堵器封堵，无残余分流。1例封堵失败，为ASD伴永存左上腔静脉引流入重度扩张的冠状静脉窦。结论TEE对于术前病例筛选，术中引导心导管、球囊和封堵器送入、定位和释放具有重要作用。     

经导管封堵治疗中老年房间隔缺损临床研究

23例中老年房间隔缺损（ASD）患者,术前经胸超声心动图（TTE）测量房间隔缺损直径为14～34mm,右房、室均不同程度增大,X线胸片示心胸比例0．52～0．70。患者均在局麻下经X线透视和TTE引导行ASD封堵术,均用国产双盘状封堵器一次封堵治疗成功,封堵器直径18～42mm。术后随访1～33个月,未见残余分流、心包填塞及封堵器移位等并发症。     

房间隔缺损封堵术后患者行心脏CTA检查的临床因素与价值

目的探讨房间隔缺损封堵术后有症状患者行心脏CT随访的临床因素及价值。方法2006年7月-2011年6月期间房间隔缺损封堵术后行CT检查的53名患者依年龄分为两组,组A,年龄兰40岁,组B〈40岁,分析患者行心脏CT检查的临床资料,包括患者年龄、临床症状、CT检查目的,CT检查结果等,进一步归纳患者行心脏CT检查的适应证及临床价值。结果共53例患者（男21,女32,平均年龄48．52,范围19—72岁）;房间隔缺损封堵术后患者行心脏CT随访的临味因素主要为胸闷、气短及心悸,患者均常规行心电图、经胸超声及X线平片复查,不能明确诊断,需进一步除外冠状动脉粥样硬化性心脏病（37／53）及肺动脉检塞（9／53）;少数病例旨在评估术后异常心前区不适（3／55）及射频消融前评估肺静脉及除外左房血栓等（4／53）。CT结果显示,全部患者均不同程度存在肺动脉扩张征象。此外,A组42例患者中,9例患者检出冠状动脉粥样硬化性心畦病;4例患者检查出并存其它先天性心血管畸形,其中冠状动脉起源异常2例,肺静脉异位引流、多发房间隔缺损各1例。B组11名患者中,3例评估术后心前区异常不适者,分别显示封堵器形态或位置异常。A、B两组虽阳性率无显著性差异（P-0．73）,但检查目的及结果不同。结论房间隔缺损封堵术后的临床症状须慎重对待,心脏CT检查能为不同年龄段的患者提供针对性的解剖学信息,有效弥补常规复查手段的不足。     

超声心动图在Amplatzer封堵器经导管治疗房间隔缺损中的价值

目的　超声心动图引导Amplatzer封堵器经导管关闭房间隔缺损 (ASD)。方法　 15例待外科手术的ASD患者 ,超声检查 [12例经食管超声心动图 (TEE)检查、3例经胸超声心动图 (TTE)检查 ]符合条件而准备行经导管ASD封堵术。在超声及X线引导下 ,以ASD最大伸展径或加 1～ 2mm为标准 ,选择Amplatzer封堵器型号 ,导管送封堵器到ASD处、释放 ,腰部卡于ASD口处 ,两伞贴于房间隔两侧。结果　 2例患者ASD最大伸展径 >34mm ,没有相应大的封堵器而放弃封堵术 ,其余 13例成功地进行了ASD封堵。超声测量ASD径非常显著小于ASD最大伸展径 [(16 92± 5 35 )mm∶(2 1 38±5 0 1)mm ,P <0 0 1],平均相差 4 46mm。术后立即、2 4h、1个月及 3个月行TTE检查 ,13例患者封堵器位置准确、稳定 ,均无残余分流。所有患者术中及术后均无并发症。结论　用Amplatzer封堵器关闭ASD ,超声在病例的选择、引导封堵器置入及术后疗效观察等方面有极重要、不可替代的作用。     

多平面经食管超声心动图测量房间隔缺损面积的研究

为了探讨新型多平面经食管超声心动图（ＭＴＥＥ）测量房间隔缺损（ＡＳＤ）面积的可行性和可靠性，在２３例ＡＳＤ患者中进行了ＭＴＥＥ检查。利用心电图门控于心动周期的Ｐ波顶点、Ｐ－Ｒ段、Ｒ波顶点、Ｊ点、Ｔ波起点、Ｔ波顶点、Ｔ波终点等７个时相，以ＭＴＥＥ技术每隔１０°扫查角度测量ＡＳＤ直径，由此绘出心动周期每一时相的ＡＳＤ图形，并计算其面积，然后与手术测量的ＡＳＤ面积进行比较。结果显示：（１）ＡＳＤ面积在心动周期中呈动态改变；（２）ＭＴＥＥ于Ｐ波顶点测量的ＡＳＤ面积与手术测值相关最佳（ｒ＝０．９２），余心动周期时相ＭＴＥＥ与手术测值亦相关良好（ｒ＝０．８２～０．８８），表明ＭＴＥＥ为ＡＳＤ面积的测量提供了可靠的新方法。     

经食管实时三维超声引导继发孔型房间隔缺损封堵的临床疗效研究

目的 研究经食管实时三维超声心动图监测和引导继发孔型房间隔缺损(ASD)封堵的临床疗效。方法 收集2018年10月至2020年6月于安徽医科大学第一附属医院心血管外科确诊并采用经食管实时三维超声引导封堵的51例继发孔型房间隔缺损患者资料,就手术失败率及术后并发症的发生、封堵器的选择、术后随访患者心脏结构和功能的变化等临床资料进行回顾性分析。结果 51例患者中成功置入Amplatzer双盘封堵器49例,手术成功率96%。术中二维测量ASD最大径为(18.34±6.29)mm,三维测量ASD最大径为(23.60±7.38)mm,两组数据之间的线性相关分析表明三维测量最大径与术中所选用封堵器型号的相关性更好。封堵治疗术后有2例封堵器边缘可见星点状残余分流,未经特殊处理,术后1月随访时分流消失。术后随访过程中患者心脏的结构和功能均进行性改善,手术疗效肯定。结论 经食管实时三维超声心动图能够有效和直观地监测、引导继发孔型房间隔缺损的封堵治疗,具有重要的临床疗效及应用价值。     

中老年房间隔缺损患者介入治疗前心脏CT检查的价值

目的 评估心脏CT在筛查拟行房间隔缺损(ASD)封堵术中老年患者合并的心血管病变及指导封堵器选择方面的价值。方法 对63例拟行ASD封堵术的50 ～ 77( 56.87±5.79)岁患者行冠状动脉CT造影检查,了解心血管病变情况。随后行ASD三维重建,并测量ASD大小。分析经胸超声心动图与CT的ASD直径测量值之间以及ASD直径的CT测量值与ASD封堵器腰部直径之间的关系。结果 14例患者依据心脏CT检查结果调整了治疗方案：8例患者诊断为ASD合并冠心病,均行常规冠心病治疗,其中2例患者行经皮冠状动脉介入治疗和ASD封堵术,1例患者行冠状动脉旁路移植术和ASD封堵术,5例患者行药物治疗和ASD封堵术;2例患者因ASD后下缘残端不完整,而放弃介入治疗;1例患者超声心动图示ASD后下缘残端不完整,而CT显示缺损边缘尚可,行ASD封堵术;除外ASD 1例;合并部分型肺静异位引流(PAPVC)1例,行外科修补术;合并动脉导管未闭1例,行动脉导管未闭和ASD封堵术。经胸超声心动图与CT的ASD直径测量值之间呈正相关(r=0.80,P＜0.01),其线性回归方程为Y=0.84X +8.85(R2=0.63,P＜0.05)。ASD直径的CT测量值与ASD封堵器腰部直径之间呈正相关(r=0.92,P＜0.01),其线性回归方程为y=0.93X +4.78(R2=0.84,P＜0.05)。结论 对于拟行ASD封堵术的中老年患者,术前心脏CT检查可有效诊断合并的冠心病及其他心血管畸形,并能指导封堵器的选择。     

成人房间隔缺损经导管Amplatzer闭合治疗经食管超声检测价值

本文介绍经食道超声 ( TEE)监测下成人房间隔缺损( ASD)经导管 Amplatzer闭合术的体会。1　资料与方法1.1　研究对象经胸壁超声心动图 ( TTE)和 TEE检查确诊的先天性心脏病继发孔中央型 ASD 11例 ,男 3例 ,女 8例 ,年龄 2 1～ 40( 3 5± 8)岁。肺动脉收缩压 2 7.9± 7.7m m Hg。均为单一缺口。1.2　仪器应用 HPSONOS新 10 0 0型彩色多普勒超声诊断仪 ,经胸壁探头频率 2 .5 MHz,TEE探头频率 5 .0 MHz。1.3　检查和监测方法常规进行 TTE检查筛选病人 ,然后行 TEE检查 ,分别在水平扫描四腔心切面和纵切扫描二房和上下腔静脉切面…     

Amplatzer法房间隔缺损封堵术一一经食管超声心动图测量值选择封堵器的可行性

目的探讨直接依据经食管超声心动图(TEE)测量值选择Amplatzer封堵器行二孔型房间隔缺损(ASD)介入治疗的疗效和安全性.方法68例行Amplatzer法治疗的ASD患者纳入研究.40例行球囊测量,并以所测直径作为选择封堵器的依据(第1组);28例不行球囊测量,直接依据术中TEE所测值选择封堵器(第2组).结果两组一般情况、超声心动图测量值、血液动力学指标、封堵器直径等均无显著性差异.第1组手术时间[(72.15±14.89)min]和透视时间[(14.37±6.72)min]均明显长于第2组[(58.71±13.43)min、(11.02±4.93)min,P＜0.001,P＜0.05].两组技术成功率为100%,并发症发生率为7.5%和10.7%,第1组术后即刻、术后24h及近期随访中完全闭合率分别为87.5%、92.5%、93.8%,第2组则分别为92.9%、96.4%、94.1%,差异均无显著性(P＞0.05).结论直接依据TEE测量值选择Amplatzer封堵器行ASD介入治疗是可行的,TEE测量值可望替代球囊测量值成为选择封堵器的最终依据.     

长年经食管超声心动图在房间隔缺损封堵治疗中的应用

目的 :经食管超声心动图 (TEE)引导置入Amplatzer封堵器治疗继发孔型房间隔缺损 (ASD)。 方法 :4例ASD患者 ,均为女性 ,年龄 8～ 39( 2 7.75± 13.96 )岁 ,体重 18～ 6 7( 4 2 .0 1± 13.2 0 )kg。在超声和X线透视指导下用Amplatzer双盘封堵ASD。术后重复TEE/经胸超声心动图 (TTE)、ECG及X线平片检查以评价疗效。结果 :4例患者封堵器置入均获成功。术中及术后未发生任何并发症。经TEE测定的ASD直径范围 13～ 2 8mm ,选择封堵器直径为 18～ 32 ( 2 5 .0± 5 .77)mm。术后 2 4h超声心动图显示 4例ASD完全闭合 ,无残余分流。3例完成术后 1个月、1例完成术后 18个月随访均无再通或封堵器移位。结论 :应用Amplatzer封堵器闭合ASD ,TEE在术前选择病例、术中引导封堵器置入及术后疗效判定等方面具有极其重要的作用     

单纯经食道超声心动图引导下经皮房间隔缺损封堵术的疗效分析

分析单纯经食管超声心动图引导下经皮行房间隔缺损封堵术的临床资料,评价方法的安全性和有效性。 方法：回顾性分析2017年6月至2018年6月采用经食道超声心动图引导经皮房间隔缺损封堵术患者共16例,操作均在普通手术室进行,单纯采用经食道超声心动图引导,在全身麻醉下,经股静脉穿刺封堵房间隔缺损。食道超声全程监测封堵全过程并评估手术效果。所有患者均在术后1个月、6个月接受经胸超声心动图复查。结果 共14例患者封堵成功,1例患者术中封堵器释放后超声心动图提示封堵器靠近下腔边缘存在大量分流,封堵器收入鞘管再次释放后仍存在残余分流,调整为经右胸小切口成功释放封堵伞,另一例术后7日出院前复查超声心动图提示封堵器脱落位于右心室内,再次行房间隔缺损修补术。随访过程中均未见明显并发症。结论 经食道超声心动图引导下可以完成大多数房间隔缺损经皮封堵术,避免放射线可能引起伤害,取得良好的临床应用效果。     

Novel use of fused cardiac computed tomography and transesophageal echocardiography for left atrial appendage closure

The use of the Watchman left atrial appendage occlusion device (Boston Scientific Inc.) is becoming increasingly frequent in patients with atrial fibrillation. Cardiac computed tomography (CT) for device sizing pre-procedure can help facilitate more accurate device selection compared with transesophageal echo (TEE) alone. CT can also help identify minor lobes and trabeculations that may not be apparent on TEE. We report a series of three cases to highlight the utility of a novel application of CT-TEE fusion imaging to provide procedural guidance during Watchman implant and to assess for peri-device leak post-implant.     

Intraoperative transesophageal echocardiography of ventricular septal defect

The accuracy and limitations of intraoperative two-dimensional (2-D) and color Doppler flow mapping transesophageal echocardiography (TEE) of ventricular septal defect (VSD), before and after cardiopulmonary bypass, were analyzed in 62 children. Twenty-one patients had an isolated VSD, and 41 had a VSD plus additional cardiac anomalies. Two-dimensional and color Doppler flow mapping TEE were performed with a miniaturized 5-MHz single (transverse) plane transducer in the 51 of 62 patients weighing less than 20 kg. The remaining 11 were monitored using a single plane adult probe (n = 4) and a biplane (transverse plus longitudinal) probe (N = 7). Prebypass TEE provided a correct diagnosis in 57 of 62 cases (92%) and corrected an erroneous preoperative transthoracic echocardiographic diagnosis in three of 62 cases (5%). Single plane TEE diagnosis was erroneous in five patients: four with doubly-committed subarterial VSD and one with multiple small apical muscular defects and pulmonary hypertension. Biplane TEE (transverse longitudinal) provided clear and complete imaging of the right ventricular outflow tract in all seven cases in whom it was used. Postbypass TEE showed absence of a hemodynamically significant residual VSD in 30 of 40 patients (95%) who underwent VSD patch closure, prospectively identified two of 40 with significant residual VSD, and accurately measured the color Doppler jet width of all residual VSDs. We conclude that hemodynamically significant VSDs can be identified immediately after cardiopulmonary bypass based on the width of the residual VSD color Doppler flow map jet. Therefore, 2-D and color Doppler flow mapping TEE provide an accurate diagnosis in most cases of VSD but may miss doubly-committed subarterial and apical muscular VSD unless biplane TEE is used.     

Double atrial septal defect: diagnosis and closure guidance with 3D transesophageal echocardiography

Atrial septal defect (ASD) is a common form of congenital heart disease that often persists well into adulthood before discovery or intervention. The authors report the case of a patient referred for routine percutaneous ASD closure that was found on three-dimensional (3D) transesophageal echocardiography to have two large separate ostium secundum defects which were subsequently closed under 3D echocardiographic guidance.     

Detection of atrial septal defect by contrast-enhanced ultrafast computed tomography

A 53-year-old man with previous surgically corrected pulmonic valve stenosis was evaluated for central cyanosis. A right-to-left shunt at the atrial level was diagnosed by contrast-enhanced ultrafast computed tomography. Cardiac catheterization confirmed the CT findings and provided quantitation of the shunt.     

Detection of sinus venosus atrial septal defect by two-dimensional echocardiography.

In a 4-year period, 10 patients (mean age, 3.6 years) with a superior type sinus venosus atrial septal defect were investigated by two-dimensional echocardiography. The defects were easily visualized in all patients using a long axis vena cava superior-inferior plane with a subcostal approach, while the atrial septum seemed to be intact in the coronal plane conventionally used for atrial septal defects of the primum or secundum type. Additional colour flow mapping, performed in two patients, demonstrated shunting across the depicted defect. In our experience, the modified plane is of great diagnostic value in cases with a sinus venosus defect.     

Diagnosis and quantitative evaluation of secundum-type atrial septal defect by transesophageal Doppler echocardiography

Transesophageal echocardiography (horizontal sector scan) was performed in 11 patients with secundum atrial septal defect (ASD). In all 11 patients, transesophageal echocardiography presented the definite visualization of the defect and a clear laminar shunt flow that showed its 2 peaks in late systole and late diastole. We estimated the size of ASD and a shunt volume across the defect by using transesophageal echocardiography. The defect size determined by transesophageal echocardiography was correlated with the surgical measurement (horizontal width, r = 0.92, p less than 0.001; vertical length, r = 0.85, p less than 0.01). A significant high correlation was shown between the shunt volume measured by transesophageal echocardiography and that by Fick's method (r = 0.87, p less than 0.01). There was no significant correlation between the pulmonary to systemic flow volume (ratio) and the mean shunt flow velocity across ASD, although a high linear correlation was observed between the pulmonary to systemic flow ratio and the defect size in horizontal direction (r = 0.82, p less than 0.01). Transesophageal echocardiography used for diagnosis and quantitative evaluation of ASD could be performed easily and satisfactorily within 10 minutes. Thus, transesophageal echocardiography is a useful method in evaluation of the defect size and the shunt flow volume of ASD. The mean shunt flow velocity was not a reliable index for estimating the shunt flow volume. The defect size might be a valuable determinant of left-to-right shunt volume in ASD.