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超声心动图在小腰型封堵器闭合膜部室间隔缺损中的应用(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第4期
页码:
525-527
栏目:
临床研究
出版日期:
2009-06-25

文章信息/Info

Title:
Application of echocardiography in closing perimembranous ventricular septal defect with narrow-waist occluder
作者:
李军1; 张军1; 朱霆1; 薛洁1; 刘利勋1; 左健2; 李寰2
第四军医大学西京医院：1.超声科，2.心血管外科，陕西 西安 710032
Author(s):
LI Jun1;  ZHANG Jun1;  ZHU Ting1;  XUE Jie1; LIU Li-xun1;  ZUO Jian2;  LI Huan2
1.Department of Ultrasound Diagnosis, 2.Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xian 710032, Shaanxi, China
关键词:
超声心动描记术; 室间隔缺损; 膜部; 封堵术; 封堵器; 室间隔缺损; 小腰型
Keywords:
echocardiography;  perimemtranous ventricular septal defect;  occlusion;  narrow-waist septal occluder
分类号:
R445；R540
DOI:
-
文献标识码:
A
摘要:
目的 探讨超声心动图在小腰型室间隔缺损封堵器闭合膜部室间隔缺损(perimembranous ventricular septal defect, PmVSD)中的应用价值。 方法 使用飞利浦Sonos-5500型彩色多普勒超声诊断仪，探头频率2~4 MHz，对43例PmVSD患者术前、术中、术后进行超声心动图观测。结果 ①超声心动图测得室缺缺损口左室侧均大于右室侧，多数伴右室侧多孔(多束分流)。缺损口形态为不规则形或瘤形。②心血管造影测量缺损口左右室侧大小并与超声测量值比较，结果无显著性差异。③封堵器型号为4~14（7.7±2.5）mm，1例释放后出现少量残余分流，术后3 d消失，余成功封堵；3例少量三尖瓣返流，近期随访观察未见明显异常。结论 PmVSD缺损口形态复杂，变异较大，超声心动图指导应用小腰型封堵器闭合可获得满意的近期疗效。
Abstract:
AIM: To investigate the value of echocardiography in closing perimembranous ventricular septal defect (PmVSD) with narrow-waist occluder. METHODS: Forty three patients were examined by PHILIPS Sonos 5500 color Doppler imaging system with 2-4 MHz transducer, including measuring and monitoring before, during, and immediately after closing and during follow-up. RESULTS: Size of the left side of the VSD measured by echocardiography was larger than the right side. Most right-side VSD defects were visualized as multiholes or multishunts. VSD shapes were irregular or neoplastic. No significant difference was found between measurements of cardiovascular angiography and echocardiography. The size of the occluder was 4-14 (7.7±2.5) mm. All cases were successfully occluded except one case with trivial residual shunt, which disappeared after 3 days. Short-term follow-up was conducted in the three cases with trivial tricuspid valve regurgitations and no abnormality was observed. CONCLUSION: PmVSDs have different shapes with significant differences. Echocardiography can be used to obtain satisfactory curative effects in occluding PmVSD with narrow-waist occluder.

参考文献/References

［1］ Hijazi ZM, Hakim F, Haweleh AA, et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: initial clinical experience［J］. Catheter Cardiovasc Interv, 2002, 56(4):508-515.

［2］ 李红梅,叶季鲜,高群，等. 国产对称双盘状封堵器经导管治疗室间隔缺损21例［J］. 心脏杂志， 2005， 17（6）：597-599.

［3］ 李军，张军，姚志勇，等. 经胸超声心动图对室间隔缺损封堵术的选择标准和方法学研究［J］. 中国超声医学杂志， 2003， 19(8):584-587.

［4］ 李军，张军，张玉顺，等. 经胸超声心动图在国产双盘伞封堵室间隔缺损的应用价值［J］. 中国超声医学杂志， 2004， 20(4):273-275.

［5］ 汪曾炜，刘维永，张宝仁,等. 心脏外科学［M］. 北京： 人民军医出版社， 2003:847-849.

［6］ 李军，张军，石晶，等. 膜部室间隔缺损形态、大小与封堵器的选择［J］. 中国医学影像技术， 2005， 21(5):712-714.

［7］ Carminati M, Butera G, Chessa M, et al. Transcatheter closure of congenital ventricular septal defect with Amplatzer septal occluders［J］. Am J Cardiol, 2005, 96(12A):52L-58L.

［8］ Fu YC, Bass J, Amin Z, et al. Transcatheter closure of perimembranous ventricular septal defect using the new Aampatzer membranous VSD occlueder:results of the U.S. phase I trial［J］. J Am Coll Cardiol, 2006, 47(2):319-325.

［9］ Carminati M, Butera G, Chessa M, et al. Trascatheter closure of congenital ventricular septal defects results of the European registry［J］. Eur Heart J, 2007, 28(19):2361-2368.

备注/Memo

备注/Memo:
收稿日期：2008-10-28.基金项目：陕西省攻关课题基金资助［2005K12-G5(14)］ 通讯作者：李军，主任医师，主要从事心血管疾病的超声诊断 及介入治疗Email:usound@fmmu.edu.cn
更新日期/Last Update: 2009-06-15