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目的评估联合使用经胸超声心动图(TTE)和经食道超声心动图(TEE)指导经皮房间隔缺损(ASD)封堵术的可靠性。方法 120例患者入选该研究。所有患者均接受术前TTE及TEE检查,术中TTE引导下房间隔封堵器释放。根据房间隔封堵器(ASO)直径分为2组,≥24 mm为A组,<24 mm为B组,同时每组又以ASD前缘是否缺失分为两个亚组。所有患者于封堵后24 h、1月、3月、6月随访TTE及心电图检查。结果 ASD封堵成功率在两组分别为94%和100%。A组中ASD的TEE测值与TTE测值差值为(2.7±2.8)mm,B组为(1.7±2.0)mm,P<0.05。ASO直径分别与TEE和TTE所测ASD最大径的差值,A组分别为(4.87±1.10)mm和(7.51±2.72)mm,B组分别为(4.20±0.80)mm和(5.89±2.26)mm,P均<0.05。相关分析提示TEE测值与ASO直径的相关性较TTE测值与ASO直径的相关性高。回归分析提示TEE测值和TTE测值与ASO直径有线性回归关系。ASD前缘有或无的患者封堵成功率比较差异无统计学意义。A组中4例封堵失败,1例出现封堵器移位,1例出现Ⅱ度二型房室传导阻滞,1例出现脑卒中;B组未发生并发症。结论术前TTE联合TEE检查、术中TTE介导下ASD封堵成功率高,并发症较少,是一种有效、安全的ASD封堵指导方法,对于ASD前缘缺如的患者同样适用。
Objective To assess the reliability of transcatheter atrial septal defect (ASD) closure combined with transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). Methods 120 patients were enrolled in this study. All patients underwent preoperative TTE and TEE examinations, and underwent TTE-guided atrial septal occluder release. According to the diameter of atrial septal occluder (ASO) divided into two groups, ≥ 24 mm for the A group, <24 mm for the B group, while each group with ASD leading edge is missing divided into two subgroups. All patients were followed up TTE and ECG on 24 h, January, March and June after occlusion. Results The success rate of ASD occlusion in both groups was 94% and 100% respectively. The difference between TEE and TTE in ASD was (2.7 ± 2.8) mm in group A and (1.7 ± 2.0) mm in group B, P <0.05. (4.87 ± 1.10) mm and (7.51 ± 2.72) mm in group A and (4.20 ± 0.80) mm and (5.89 ± 2.26) mm in group B, respectively mm, P <0.05. Correlation analysis suggested that the correlation between TEE and ASO diameter was higher than TTE and ASO diameter. Regression analysis suggested a linear regression between TEE and TTE measurements and ASO diameter. There was no significant difference in the success rate of occlusion between patients with and without ASD. In group A, occlusion of four cases failed, in one case, occluder displacement occurred, in one case, degree Ⅱ-type atrioventricular block was observed, and in one case, stroke occurred; in group B, no complications occurred. Conclusions The preoperative TTE combined with TEE examination has a high success rate of ASD occlusion during operation and less complications. It is an effective and safe method of ASD occlusion guidance and is equally applicable to patients with ASD anterior margin.