Ding Xun-Shi, Feng Yuan, Xu Jian-Jun, Chen Yu-Cheng, Zeng Zhi, Rao Li
Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2010 Jul;41(4):644-7.
To evaluate the reliability of the combined use of TTE and TEE in guiding percutaneous closure of atrial septal defect.
A total of 120 patients were recruited, all accepting TTE and TEE examinations before surgery. The release of ASD occluders was guided by TTE. The patients were divided into two groups. Patients in Group A received ASD occluders with > or = 24 mm diameter. Group B received ASD occluders with < 24 mm diameter. Each group comprised patients with and without retroaortic rim. The patients were followed up with TTE and ECG examinations 24 h, 1, 3 and 6 months after the procedure.
ASD closure was successful for 94% and 100% of the patients in group A and group B, respectively. The difference of the ASD diameter measured by TEE and TTE was (2.7 +/- 2.8) mm in group A and (1.7 +/- 2) mm in group B, P < 0.05. The ASD diameter measured by TEE had a (4.87 +/- 1.10) mm and (4.2 +/- 0.80) mm difference with the diameter of ASD occluders for patients in Group A and Group B, respectively (P < 0.05). The ASD diameter measured by TTE had a (7.51 +/- 2.72) mm and (5.89 +/- 2.26) mm difference with the diameter of ASD occluders for patients in Group A and Group B, respectively (P < 0.05). The ASD diameter measured by TEE had a greater correlation coefficient with the ASD occluder diameter than that measured by TTE. The ASD diameters measured by TEE(x1) and TTE(x2) were both linearly correlated with the ASD occluder diameter(y). There was no difference in the successful rate of ASD closure between the patients with and without deficient retroaortic rim. In group A, the procedure failed in 4 patients; misalignment of the ASD occlude occurred in one patient; one patient suffered from second degree type II atrio-ventricular block; one patient had ischemic cerebral stroke. No such complications occurred in group B.
The combined use of TTE and TEE before the intervention procedure and the release of ASD occluder guided by TTE enables high successful closure rate with little complication. It is an effective and safe method. It can be performed in patients with deficient retroaortic rim.
评估经胸超声心动图（TTE）和经食管超声心动图（TEE）联合应用在指导经皮房间隔缺损封堵术中的可靠性。
共纳入120例患者，均在手术前行TTE和TEE检查。TTE引导房间隔缺损封堵器的释放。患者分为两组。A组患者接受直径≥24mm的房间隔缺损封堵器。B组患者接受直径＜24mm的房间隔缺损封堵器。每组均包含有和没有主动脉后缘的患者。术后24小时、1个月、3个月和6个月对患者进行TTE和心电图检查随访。
A组和B组患者房间隔缺损封堵成功率分别为94%和100%。A组TEE和TTE测量的房间隔缺损直径差值为（2.7±2.8）mm，B组为（1.7±2）mm，P＜0.05。A组和B组患者TEE测量的房间隔缺损直径与房间隔缺损封堵器直径分别相差（4.87±1.10）mm和（4.2±0.80）mm（P＜0.05）。A组和B组患者TTE测量的房间隔缺损直径与房间隔缺损封堵器直径分别相差（7.51±2.72）mm和（5.89±2.26）mm（P＜0.05）。TEE测量的房间隔缺损直径与房间隔缺损封堵器直径的相关系数大于TTE测量的。TEE（x1）和TTE（x2）测量的房间隔缺损直径均与房间隔缺损封堵器直径（y）呈线性相关。有和没有主动脉后缘缺损的患者房间隔缺损封堵成功率无差异。A组有4例患者手术失败；1例患者房间隔缺损封堵器位置不正；1例患者发生二度II型房室传导阻滞；1例患者发生缺血性脑卒中。B组未发生此类并发症。
介入手术前联合应用TTE和TEE并由TTE引导房间隔缺损封堵器的释放可实现高封堵成功率且并发症少。这是一种有效且安全的方法。可用于有主动脉后缘缺损的患者。
