经胸及经食道超声在房间隔缺损封堵术中的应用
Application of transthoracic and transesophageal echocardiography in transcatheter occlusion of atrial septal defect

摘要：目的 探讨经胸超声心动图(transthoracic echocardiography, TTE)和经食道超声心动图(transesophageal echocardiography, TEE)在房间隔缺损(atrial septal defect, ASD)介入封堵术中的应用特点和价值。方法 回顾性分析2011年10月～2014年10月间在本院实施ASD介入封堵术患者的相关资料，探讨经胸、经食道超声术前对房间隔缺损的测量值及其与所选封堵器大小的关系。结果 ①69例房间隔缺损封堵术患者，TEE评估适合实施封堵术者65例，最后成功实施封堵者60例(86.96%，60/69)，手术顺利，术后无并发症；②成功封堵患者中ASD缺损径的TEE测量值均显著大于TTE测量值，差异有统计学意义(P<0.05)，最大缺损径的TEE测值显著大于TTE测值，差异有统计学意义(P<0.05)；缺损最大径的TEE测值与封堵器大小的相关性高于TTE。结论 TEE对ASD缺损口大小、残缘情况的评估更接近缺损实际且优于TTE，但对整体评价存在不足；在房间隔伸展径的评估中TTE优于TEE，建议ASD封堵术前应行TEE作为TTE的补充。
ABSTRACT: Objective To discuss the application characteristics and value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in transcatheter occlusion of atrial septal defect (ASD). Methods We made a retrospective analysis of patients with transcatheter occlusion of ASD treated in our hospitals from October 2011 to October 2014. We studied the different measurements between TTE and TEE for ASD, and their relationship with the size of occlusion device. Results ① TEE evaluation was suitable for implementing surgery on 65 patients with transcatheter occlusion of ASD out of 69 ones; 60 of them were successful (86.96%, 60/69), and there was no postoperative complication. ② In successful 60 ones, ASD defect diameter of TEE in the patients was significantly greater than that of TTE (P<0.05), the maximum diameter of TEE was significantly greater than that of TTE, the differences were significant (P<0.05). The correlation between the defect maximum diameter with TEE and selected size of the occlusion device was higher than TTE. Conclusion In terms of the size and residual edge of ASD, assessment for TEE is closer to the actual defect and is superior to TTE. However, TEE has some drawbacks in the overall evaluation and TTE is better than TEE in assessing the stretch diameter of atrial septum. It is suggested that transcatheter occlusion should be performed on patients before TTE as a supplement of TEE