Acar P
Unit of Pediatric Cardiology, Hôpital des Enfants, Toulouse, France.
Minerva Pediatr. 2004 Feb;56(1):29-40.
The selection of patients for transcatheter or surgical closure of a secundum atrial septal defect requires accurate information regarding the anatomy of the defect such as its maximal diameter and the amount of circumferential tissue rim. Two-dimensional echocardiography is wanting as a means to define selection criteria for atrial septal defect closure. Since the defect is visualised from multiple orthogonal planes, maximal atrial septal defect diameter is widely under-estimated. The transcatheter approach measures the stretched diameter, but cannot be applied alone for patient selection since it does not provide information on the tissue rim. Three-dimensional echocardiography allows unique en face views of the atrial septum. Previous studies have shown the ability of 3-dimensional echocardiography to depict information regarding the shape, the maximal diameter and the rims surrounding the defect. Transthoracic 3-dimensional echocardiography is accurate to measure atrial septal defect maximal diameter and rims surrounding the defect. Such a non-invasive method could be applied to children selection for atrial septal defect closure. The transcatheter balloon method provides additional information such as the resistance of the septum. Device sizing and placement should take into account both 3-dimensional echocardiography and transcatheter findings.
选择经导管或手术闭合继发孔型房间隔缺损的患者需要有关缺损解剖结构的准确信息,如最大直径和圆周组织边缘的长度。二维超声心动图作为确定房间隔缺损闭合选择标准的手段存在不足。由于缺损是从多个正交平面观察的,房间隔缺损的最大直径被广泛低估。经导管方法测量的是拉伸直径,但不能单独用于患者选择,因为它不能提供有关组织边缘的信息。三维超声心动图可提供独特的房间隔正面视图。先前的研究表明,三维超声心动图能够描绘有关缺损的形状、最大直径和周围边缘的信息。经胸三维超声心动图可准确测量房间隔缺损的最大直径和缺损周围的边缘。这种非侵入性方法可应用于选择房间隔缺损闭合的儿童。经导管球囊法可提供额外信息,如隔膜的阻力。装置的尺寸选择和放置应同时考虑三维超声心动图和经导管检查结果。