TEE引导下经胸微创封堵治疗先天性心脏病

目的探讨TEE引导下经胸介入封堵治疗先天性心脏病(CHD)的临床应用价值。方法回顾50例接受TEE引导下经胸介入封堵治疗的CHD患者的资料,包括29例室间隔缺损(VSD)、12例房间隔缺损(ASD)、1例ASD合并VSD及8例动脉导管未闭(PDA),封堵前均经TEE再次明确诊断并观察心脏缺损情况,术中超声实时监测并引导导丝、鞘管等到达指定位置及封堵伞放置,术后超声观察有无残余分流、瓣膜功能障碍评以价封堵效果,并通过心电图监测患者有无心律失常、传导阻滞。结果 49例介入封堵成功,其中11例术后即刻TEE可见残余分流;术后1、3、6个月复查TEE,49例均显示封堵器位置良好,无残余分流及封堵术导致的瓣膜反流,复查心电图未见心律失常及传导阻滞。1例VSD介入封堵失败。结论 TEE用于引导经胸介入封堵治疗CHD安全、有效且创伤小、无辐射、无需对比剂,操作简便,值得临床推广应用。

Application of TEE-guided minimally invasive congenital heart disease occlusion

Objective To investigate the clinical value of TEE-guided interventional occlusion for treating congenital heart disease (CHD). Methods Clinical data of 50 CHD patients who underwent TEE-guided minimally invasive closure were analyzed retrospectively. There were 29 cases of ventricular septal defect (VSD), 12 cases of atrial septal defect (ASD), 1 case of ASD combined with VSD and 8 cases of patent ductus arteriosus (PDA). The interventional occlusions were performed through transthoracic approach. Before occlusion, TEE was used to diagnose and observe the heart defect again, while intraoperative TEE was used for real-time monitoring and guiding the wire and sheath aimed to the designated position and occlusion umbrella placement. Postoperative TEE was also performed to evaluate the occlusion effect. Electrocardiogram was used to monitor the arrhythmia and conduction block of patients. Results Interventional occlusions were successfully performed in 49 cases under the guidance of TEE. Remaining shunts were found in 11 patients with TEE immediately after interventional occlusion. TEE reexamined at 1, 3 and 6 months after operation showed satisfied occluder position in all 49 patients. Neither residual shunt nor valve regurgitation caused by occlusion was found. And there was no arrhythmia and conduction block detected with ECG. The occlusion of VSD failed in 1 patient. Conclusion TEE is a safe, effective, minimally invasive, radiation-free and needing no contrast media method for guiding transthoracic interventional occlusion for treatment of CHD, worthy of clinical popularization and application.