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目的:探讨经食管超声心动图(TEE)对外科微创室间隔缺损封堵术的应用价值。方法:回顾性分析2013年8月至2015年5月广州医科大学附属第一医院收治的224例TEE初筛可进行封堵的室间隔缺损(VSD)患者的临床资料,术中全部行TEE全程监测封堵过程,引导封堵器放置,术后即刻评价疗效。结果:224例VSD患者中成功实行封堵术206例,成功率为92%。手术时间30~255 min,平均时间(70.2±35.3)min。术后1年内定期随访,无封堵器脱落、移位、溶血和房室传导阻滞等并发症发生,仅2例出现中量以上残余分流和瓣膜反流。术后第一次复查时,左室舒张末内径为(29.3±5.9)mm,左室射血分数为(63.5±6.7)%,均较术前的(33.8±6.7)mm和(71.6±5.6)%明显降低(P<0.05)。结论:经食管超声心动图对室间隔缺损微创封堵术病例术前评估、术中监测引导及术后即刻评价疗效均有重要而可靠的应用价值。
Objective: To investigate the value of transesophageal echocardiography (TEE) in the surgical closure of minimally invasive ventricular septal defect. Methods: The clinical data of 224 patients with ventricular septal defect (VSD) who underwent primary TEE screening in the First Affiliated Hospital of Guangzhou Medical University from August 2013 to May 2015 were retrospectively analyzed. All the patients underwent TEE throughout the procedure Monitor the occlusion process, guide the occluder placed, evaluate the effect immediately after surgery. Results: Among 224 patients with VSD, 206 cases were successfully blocked with a success rate of 92%. The operation time was 30 to 255 minutes and the average time was 70.2 ± 35.3 minutes. Regular follow-up within 1 year after surgery did not cause occlusion, displacement, hemolysis and atrioventricular block and other complications occurred, only 2 cases appeared in the amount of residual shunt and valve regurgitation. At the first postoperative follow-up, the end-diastolic diameter of the left ventricle was (29.3 ± 5.9) mm and the left ventricular ejection fraction was (63.5 ± 6.7)%, which were significantly higher than those of preoperatively (33.8 ± 6.7) mm and (71.6 ± 5.6) )% Was significantly lower (P <0.05). Conclusion: The trans-esophageal echocardiography is an important and reliable method for the minimally invasive closure of ventricular septal defects in patients with preoperative assessment, intraoperative monitoring and guidance and immediate evaluation of the curative effect.