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目的评价经食管超声心动图引导下经胸小切口行先天性心脏病漏斗部室间隔缺损封堵术的临床疗效和安全性。方法回顾性分析2013年1~6月河北省儿童医院21例漏斗部室间隔缺损患儿经食管超声心动图引导下经胸小切口行漏斗部室间隔缺损封堵术的临床资料,其中男10例、女11例,年龄8~24(16±8)个月,体重(9±3)kg,室间隔缺损大小(4.5±2.5)mm。经食管超声心动图引导下完成21例经胸小切口漏斗部室间隔缺损封堵术。用经食管超声心动图评估封堵器的位置、对房室瓣和主动脉瓣的影响以及有无残余分流。结果无围术期死亡和并发症发生。21例室间隔缺损患儿中20例成功封堵,成功率95.2%。其中1例因缺损太大,转为体外循环下直视室间隔缺损修补术。安置封堵器时间(32±16)min,封堵器大小(5±3)mm;住院时间6~8 d。所有患者术后随访3~6个月,随访期间超声心动图提示:封堵器回声清晰,位置正常,无轻度以上残余分流和瓣膜反流。结论经食管超声心动图引导下经胸小切口行漏斗部室间隔缺损封堵术易于操作、疗效确切、安全可靠。
Objective To evaluate the clinical efficacy and safety of transesophageal echocardiography guided transcatheter closure of ventricular septal defect with congenital heart disease undergoing small incision. Methods The clinical data of 21 patients with funnel ventricular septal defect admitted to Children’s Hospital of Hebei Province from January to June 2013 underwent transesophageal echocardiography guided by funnel and ventricular septal defect closure were retrospectively analyzed. Among them, 10 were male, There were 11 females, aged 8-24 (16 ± 8) months, weighing 9 ± 3 kg and ventricular septal defect size 4.5 ± 2.5 mm. Under the guidance of transesophageal echocardiography, 21 cases of transthoracic incision funnel ventricular septal defect occlusion were completed. Transesophageal echocardiography was used to assess the effect of occluder placement on atrioventricular and aortic valves and residual shunting. Results Perioperative deaths and complications occurred. Twenty cases of 21 cases of ventricular septal defect were successfully occluded, with a success rate of 95.2%. One case of defect due to too much, undergoing cardiopulmonary bypass undergoing open ventricular septal defect repair. Time of placement occluder (32 ± 16) min, occluder size (5 ± 3) mm; length of stay 6 ~ 8 days. All patients were followed up for 3 to 6 months. Echocardiography during follow-up suggested that the occluder had a clear echo and a normal position with no residual residual shunt and valvular regurgitation. Conclusion Transesophageal ectopic septal defect blockage guided by transthoracic incision guided by transesophageal echocardiography is easy to operate. The curative effect is exact, safe and reliable.