El-Said H G, Bezold L I, Grifka R G, Pignatelli R H, McMahon C J, Schutte D A, Smith E O, Mullins C E
Texas Children's Hospital, and the Department of Pediatrics, Baylor College of Medicine, Houston 77030, USA.
Tex Heart Inst J. 2001;28(3):177-82.
We conducted this retrospective study to compare methods for measuring atrial septal defects and to identify factors affecting echocardiographic measurement of such defects before transcatheter closure with the CardioSEAL'Septal Occluder. We reviewed the records of patients considered for device placement at our institution from January 1997 to April 1999. Atrial septal defect size was measured by transthoracic and transesophageal echocardiography; the stretched diameter was measured during catheterization by fluoroscopy and transesophageal echocardiography. The stretched-diameter fluoroscopic measurement was used for device size selection. Analysis of variance was used to calculate the effect of size, age, and size-by-age interaction. Thirty-one patients (3.3 to 72 years of age) underwent transthoracic and transesophageal echocardiography One patient was excluded from catheterization because of a 25-mm septal defect as indicated by transesophageal echocardiography (our maximum diameter, 15 mm). Thirty patients underwent transcatheter stretched-diameter sizing; 5 were excluded from device implantation because of defects >20 mm by stretched-diameter fluoroscopy (4) or septal length insufficient for device support (1). Implantation was successful in 23/25 patients; 2/23 had a residual shunt. In patients with available results (26/30), the stretched diameter was the same whether measured by stretched-diameter fluoroscopy or transesophageal echocardiography (P=0.007 R square=0.963). Compared with stretched-diameter fluoroscopy, precatheterization transthoracic and transesophageal echocardiography underestimated defect size by a mean of 22% and 13.2%, respectively. When data from those same tests were compared in defects of < or =0 mm and > 10 mm, transthoracic and transesophageal echocardiography were reliable predictors (P=0.003 and P=0.05, respectively) of stretched-diameter size in defects < or =0 mm.
我们开展这项回顾性研究，旨在比较测量房间隔缺损的方法，并确定在使用CardioSEAL房间隔封堵器进行经导管封堵术前影响此类缺损超声心动图测量的因素。我们回顾了1997年1月至1999年4月在我院考虑进行器械置入的患者记录。通过经胸和经食管超声心动图测量房间隔缺损大小；在导管插入术中通过荧光透视和经食管超声心动图测量伸展直径。伸展直径的荧光透视测量用于选择器械尺寸。采用方差分析来计算大小、年龄以及大小与年龄交互作用的影响。31例患者（年龄3.3至72岁）接受了经胸和经食管超声心动图检查。1例患者因经食管超声心动图显示25mm的房间隔缺损（我们最大直径为15mm）而被排除在导管插入术之外。30例患者接受了经导管伸展直径测量；5例因伸展直径荧光透视显示缺损>20mm（4例）或间隔长度不足以支撑器械（1例）而被排除在器械植入之外。23/25例患者植入成功；2/23例有残余分流。在有可用结果的患者（26/30）中，无论通过伸展直径荧光透视还是经食管超声心动图测量，伸展直径都是相同的（P = 0.007，R平方 = 0.963）。与伸展直径荧光透视相比，导管插入术前经胸和经食管超声心动图分别平均低估缺损大小22%和13.2%。当在≤10mm和>10mm缺损中比较相同检查的数据时，经胸和经食管超声心动图分别是≤10mm缺损中伸展直径大小可靠预测指标（分别为P = 0.003和P = 0.05）。
