Zhang Li-Hua, Li Zhi-An, Lin Chang-Yan, Zhang Chun
Institute of Biomedical Engineering, Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2008 Mar 11;88(10):691-3.
To evaluate the clinical value of transesophageal echocardiography (TEE) in guiding intraoperative device closure of secundum atrial septal defect (ASD).
Fifty ASD patients, aged 40 +/- 18 (15-72), 34 with an ASD ranging from 30 to 40 mm and 16 with atrial septal aneurysm accompanied by double or more ASDs, underwent intraoperative device closure through a right minithoracotomy without cardiopulmonary bypass and fluoroscopy. Under general anesthesia, a probe was inserted into the esophagus, and TEE was conducted at different planes to observe the characteristics of the ASD. The size of implanted device was determined by TEE. Small parasternal incision was made in the right third or fourth intercostal space. A specially designed plastic sheath loaded with Amplatzer occlusion device was inserted through the purse-string sutures placed on the right atrium. Guided by transesophageal echocardiography, the Amplatzer occlusion device was advanced through the ASD into the left atrium and was deployed in place. The right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVSV), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular stroke volume (LVSV), and left ventricular ejection fraction (LVEF) before and after the operation were calculated.
The procedure was successful conducted in 48 patients. And the other two patients failing to receive this procedure, one having a large ASD that could not be occluded and the other with ASD accompanied by partial anomalous pulmonary venous connection, were shifted to operation with cardiopulmonary bypass. After the operation, the RVEDV was (94 +/- 32) ml, and the RVSV was (52 +/- 20) ml respectively, both significantly lower than those before the operation [(78 +/- 23) ml and (41 +/- 13) ml respectively, both P < 0.05]. The LVEDV and LVSV after operation were (73 +/- 19) ml and (50 +/- 11) ml respectively, both significantly higher than those before operation [(56 +/- 14) ml and (34 +/- 12) ml respectively, both P < 0.05].
TEE provides valuable information in further confirmation of diagnosis of ASD, selection of appropriate size of Amplatzer occluder, guidance of the deployment of occluder, observation of the effects of operation, and prompt detection of complication.
评估经食管超声心动图（TEE）在指导房间隔缺损（ASD）继发孔术中封堵器置入的临床价值。
50例ASD患者，年龄40±18（15 - 72）岁，其中34例ASD直径为30至40mm，16例伴有房间隔瘤合并两个或更多ASD，在非体外循环及无透视下经右胸小切口行术中封堵器置入术。全身麻醉下，将探头插入食管，在不同平面行TEE以观察ASD特征。根据TEE确定植入封堵器的大小。在右第三或第四肋间做小胸骨旁切口。将装载有Amplatzer封堵器的特制塑料鞘通过置于右心房的荷包缝线插入。在经食管超声心动图引导下，将Amplatzer封堵器经ASD推进至左心房并释放到位。计算手术前后右心室舒张末期容积（RVEDV）、右心室收缩末期容积（RVESV）、右心室每搏量（RVSV）、右心室射血分数（RVSV）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室每搏量（LVSV）及左心室射血分数（LVEF）。
48例患者手术成功。另外2例未接受该手术，1例因ASD过大无法封堵，另1例ASD合并部分性肺静脉异位连接，转至体外循环下手术。术后RVEDV为（94±32）ml，RVSV为（52±20）ml，均显著低于术前[分别为（78±23）ml和（41±13）ml，P均<0.05]。术后LVEDV和LVSV分别为（73±19）ml和（50±11）ml，均显著高于术前[分别为（56±14）ml和（34±12）ml，P均<0.05]。
TEE在进一步明确ASD诊断、选择合适大小的Amplatzer封堵器、指导封堵器释放、观察手术效果及及时发现并发症方面提供了有价值的信息。
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