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目的探讨经食管超声心动图(transesophageal echocardiography,TEE)在经胸微创封堵治疗室间隔缺损(ventricular septal defect,VSD)中的应用价值。方法44例VSD患儿,术前经胸超声心动图(transthoracic echocardiography,TTE)检查诊断单纯性膜周部VSD 34例(其中呈膜部瘤状18例)、嵴内型VSD 10例。采用TEE再次评估VSD大小,放置封堵器,实时动态评价封堵效果;术后3d及3、6、12个月采用TTE定期评价心内结构及功能,同步检测心电图、血常规及尿常规等。结果 44例中38例封堵成功,成功率为88%,其中33例放置等边型VSD封堵器,4例放置偏心型VSD封堵器,1例放置小腰大边型VSD封堵器;6例改行体外循环辅助下心内直视修补术。术后3d及3、6、12个月行TTE检查,无封堵器脱落、移位,严重心律失常发生。结论 TEE在经胸外科微创封堵术治疗VSD尤其是膜周部VSD和嵴内型VSD中有重要价值。
Objective To investigate the value of transseptal transesophageal echocardiography (TEE) in the treatment of ventricular septal defect (VSD) by transthoracic minimally invasive sealing. Methods Forty - four patients with VSD were diagnosed by transthoracic echocardiography (TTE) in 34 cases of VSD. Among them, there were 34 cases with membranous tumor and 10 cases with intracristal VSD. The size of VSD was re-evaluated by TEE, and the occlusion effect was evaluated in real-time and dynamically. The structure and function of heart were evaluated regularly by TTE on the 3rd and 3rd, 6th and 12th month after operation. The electrocardiogram, blood routine and urine routine . Results Of the 44 cases, 38 cases were successfully occluded, with a success rate of 88%. 33 cases had equilateral VSD occluder, 4 cases placed eccentric VSD occluder, and 1 case had small lumbar large side VSD occluder ; 6 cases underwent extracorporeal cardiopulmonary bypass repair with open heart surgery. TTE was performed on the 3rd, 3rd, 6th and 12th months after operation. There was no exfoliation and displacement of the occluder and severe arrhythmia occurred. Conclusion TEE is of great value in the treatment of VSD, especially in the peritumoral VSD and intracristal VSD by minimally invasive thoracotomy.