目的探讨食管超声(TEE)在小儿经胸微创室间隔缺损(VSD)封堵术中的应用价值。方法经胸超声心动图(TTE)检查筛选150例VSD患儿,拟行经胸微创VSD封堵治疗。术中行TEE检查根据VSD部位、类型、大小选择封堵器型号,确定胸壁切口及右心室壁穿刺点位置,指引导丝及鞘管进入并释放封堵器,评价封堵效果。结果 TEE测量VSD大小与封堵器型号具有良好相关性;150例患儿中141例患儿封堵成功,其中12例出现少量新增房室瓣或动脉瓣反流,3例存在微量残余分流,2例延长胸壁切口,3例变更右心室壁穿刺点。9例患儿封堵失败转体外循环行常规VSD修补,其中4例导丝无法进入左室,3例封堵器脱落,1例存在不能接受的残余分流,1例中量以上主动脉瓣反流。结论 TEE对VSD大小和位置的测量、手术入路的确定、封堵器的选择和释放、即刻疗效评价均有重要价值。 Objective To investigate the value of esophageal ultrasonography (TEE) in the closure of pediatric patients with transthoracic minimally invasive ventricular septal defect (VSD). Methods Totally 150 children with VSD were selected through transthoracic echocardiography (TTE) examination and were scheduled to undergo thoracic minimally invasive VSD closure. Intraoperative TEE examination according to the VSD site, type, size, select the occluder model to determine the location of the chest wall incision and right ventricular puncture point, guide the guide wire and sheath into and release occluder to evaluate the blocking effect. Results There was a good correlation between the VSD size of TEE and occluder type. Among the 150 cases, 141 cases were successfully blocked, of which 12 cases had a small amount of new atrioventricular valve or aortic regurgitation and 3 cases had residual trace shunt , 2 cases to extend the chest wall incision, 3 cases to change the right ventricular wall puncture point. Nine cases failed to complete routine VSD repair by extracorporeal circulation, of which 4 cases were unable to enter the left ventricle, 3 cases had occluder shedding, 1 case had an unacceptable residual shunt, 1 case had aortic valve revascularization flow. Conclusions TEE is of great value in the measurement of VSD size and location, the determination of surgical approach, the selection and release of occluder, and the immediate efficacy evaluation.