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目的探讨经胸超声心动图(transthoracic echocardiography,TTE)在小儿继发孔房间隔缺损(atrial septal defect,ASD)微创外科封堵术前筛查中的应用价值。方法以2012-01~12月经TTE筛查并行外科微创封堵治疗的20例单纯继发孔房间隔缺损小儿患者(≤15岁)为研究对象,回顾性分析其术前经胸超声心动图筛查资料、术中经食道超声心动图(transesophageal echocardiography,TEE)评估资料及手术结果。结果封堵成功率95%(19/20)。TTE和TEE测量参数比较,各切面ASD缺损径及最大缺损径测值差异无统计学意义(P>0.01);测值间具有较高相关性(P<0.01),且剑突下双房切面的测值相关性高于胸骨旁切面测值。封堵成功病例的最大ASD缺损径TTE测值与封堵器大小间呈高度正相关(r=0.873),相关系数稍低于TEE测值(r=0.972)。结论 TTE在低龄小儿患者的ASD外科微创封堵治疗术前筛查方面具有重要价值,可代替TEE成为封堵术前筛选病例的主要方法,尤其是剑突下切面,可以作为小儿患者术前筛查的重点观察切面。
Objective To investigate the value of transthoracic echocardiography (TTE) in preoperative screening of minimally invasive surgical closure of secondary atrial septal defect (ASD) in children. Methods Twenty patients with simple secondary atrial septal defect (≤15 years) who underwent TTE screening and minimally invasive surgical closure during 2012-01 were retrospectively analyzed. The preoperative transthoracic echocardiography Screening data, intraoperative transesophageal echocardiography (transesophageal echocardiography, TEE) evaluation of data and surgical results. Results The success rate of occlusion was 95% (19/20). There was no significant difference between the measured parameters of TTE and TEE (P> 0.01), and the correlation between the measured values was significant (P <0.01) The measured correlations were higher than those measured at the paraxial section. The maximum ASD defect size TTE measured in occluded patients was highly correlated with occluder size (r = 0.873), and the correlation coefficient was slightly lower than TEE (r = 0.972). Conclusion TTE plays an important role in the preoperative screening of minimally invasive occlusion of ASD in young pediatric patients. It can replace TEE as the main method for preoperative screening of occlusion, especially the subclavian section, which can be used as preoperative Screening of key observation section.