经胸超声心动图在评估Amplatzer房间隔封堵器大小及指导房间隔缺损经皮封堵术中的可靠性。

Reliability of transthoracic echocardiography in estimating the size of Amplatzer septal occluder and guiding percutaneous closure of atrial septal defects.

作者信息

Li Gui-shuang, Kong Guang-ming, Ji Qiu-shang, Li Ji-fu, Chen Yu-guo, You Bei-an, Zhang Yun

机构信息

Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital, Shandong University, Jinan, Shandong, China.

出版信息

Chin Med J (Engl). 2008 Jun 5;121(11):973-6.

PMID:18706243

Abstract

BACKGROUND

In China, transthoracic echocardiography (TTE) is popularly used for pre-intervention examination for atrial septal defect (ASD) and for guiding ASD closure. However, the ability to determine ASD size and the safety and efficacy of TTE for guiding ASD closure still has not been widely accepted. This study aimed to evaluate the efficacy and safety of TTE used before, during and after transcatheter ASD closure with Amplatzer septal occluders (ASO).

METHODS

Sixty-eight subjects (15 men and 53 women; mean age (33.7 +/- 17.3) years) were enrolled. TTE was used to measure the diameters and guide transcatheter closure of ASD. The ASD was examined by long-axis view, basal short-axis view, apical four-chamber view and the subcostal view to observe position, diameter and relation with neighbouring structures. The largest diameter was selected as the reference diameter. Patients were divided into 3 groups according to the ASD reference diameter: 22 subjects with ASD diameter 4 - 14 mm (group A); 21 subjects with ASD diameter 15 - 20 mm (group B); and 25 subjects with ASD diameter 21 - 33 mm (group C).

RESULTS

ASD was occluded successfully in groups A and B. In group C, occlusion failed in 2 cases; 1 case remained with a 3-mm residual shunt sustained until 6-month follow-up. However, at 6-month follow-up, no case of thromboembolism, ASO dislocation or death occurred in the three groups. The diameter of ASD measured by TTE could accurately predict the ASO size that could successfully occlude the ASD, especially in patients with ASD < 20 mm. The ASD diameter measured by TTE correlated well with ASO size (r = 0.925, P < 0.001; r = 0.976, P < 0.001; r = 0.929, P < 0.001 respectively).

CONCLUSIONS

ASD diameter measured by TTE can accurately estimate the size of the ASO needed for successful closure of ASD. The larger the ASD, the much larger the ASO needed. TTE is a satisfactory guiding imaging tool for ASD closure.

摘要

背景

在中国，经胸超声心动图（TTE）广泛用于房间隔缺损（ASD）介入治疗前的检查及指导ASD封堵。然而，TTE测定ASD大小的能力以及其指导ASD封堵的安全性和有效性尚未得到广泛认可。本研究旨在评估在使用Amplatzer房间隔封堵器（ASO）经导管封堵ASD的术前、术中和术后使用TTE的有效性和安全性。

方法

纳入68例受试者（15例男性和53例女性；平均年龄（33.7±17.3）岁）。使用TTE测量ASD直径并指导经导管封堵ASD。通过长轴视图、心底短轴视图、心尖四腔视图和肋下视图检查ASD，以观察其位置、直径以及与相邻结构的关系。选择最大直径作为参考直径。根据ASD参考直径将患者分为3组：22例ASD直径为4 - 14 mm的患者（A组）；21例ASD直径为15 - 20 mm的患者（B组）；25例ASD直径为21 - 33 mm的患者（C组）。

结果

A组和B组ASD封堵成功。C组2例封堵失败；1例在6个月随访时仍有3 mm的残余分流。然而，在6个月随访时，三组均未发生血栓栓塞、ASO脱位或死亡病例。TTE测量的ASD直径能够准确预测成功封堵ASD所需的ASO大小，尤其是ASD < 20 mm的患者。TTE测量的ASD直径与ASO大小相关性良好（分别为r = 0.925，P < 0.001；r = 0.976，P < 0.001；r = 0.929，P < 0.001）。