Division of Cardiology, Department of Pediatrics, University of California, San Diego School of Medicine & Rady Children's Hospital, San Diego, California.
JACC Cardiovasc Interv. 2013 Sep;6(9):974-80. doi: 10.1016/j.jcin.2013.05.007.
This study sought to determine whether transthoracic echocardiography (TTE) can provide safety and efficacy equivalent to transesophageal echocardiography (TEE) for assessment and guidance of transcatheter atrial septal defect (ASD) closure in pediatric patients.
We performed a prospective randomized trial of ASD closure using the Amplatzer septal occluder (ASO) from March 2008 to April 2012. Inclusion criteria were isolated secundum ASD, age 2 to 18 years, and adequate TTE windows. Forty patients were enrolled and randomized to either TEE or TTE. In the TEE group, we used "stop flow" balloon sizing to determine device size. In the TTE group, we used the average ASD diameter times 1.2 (scaled). Patients were followed up to 1 year.
Patient general and hemodynamic characteristics were similar in both groups. Procedural success was 100% in both groups. The average TEE stop flow diameter was similar to the scaled TTE diameter (15.35 ± 4.62 mm vs. 16.57 ± 5.47 mm; p = 0.46). Device size (16.0 ± 4.94 mm vs. 16.37 ± 5.05 mm, p = 0.82) and ratio of device to defect size (1.0 ± 0.06 vs. 0.99 ± 0.03, p = 0.52) were also similar. Total procedure (70.6 ± 22.98 min vs. 51.1 ± 17.61 min, p = 0.005), room (126.8 ± 28.41 min vs. 95.7 ± 20.53 min, p = 0.0004), and fluoroscopy (13.6 ± 6.17 min vs. 8.9 ± 8.45 min, p = 0.007) times were all significantly shorter in the TTE group. Neither group had significant complications during the procedure nor in follow-up. Rates of shunt resolution were similar between groups.
This study suggests that in selected pediatric patients, use of TTE is as efficacious and safe as TEE for assessment and guidance of ASD occlusion using the ASO. TTE also may offer the additional safety benefit of reduced fluoroscopy exposure.
本研究旨在确定经胸超声心动图（TTE）在评估和指导儿科患者经导管房间隔缺损（ASD）封堵时是否具有与经食管超声心动图（TEE）相当的安全性和有效性。
我们于 2008 年 3 月至 2012 年 4 月进行了一项使用 Amplatzer 房间隔封堵器（ASO）进行 ASD 封堵的前瞻性随机试验。纳入标准为孤立性继发 ASD、年龄 2 至 18 岁、具有足够的 TTE 窗口。共有 40 例患者入选并随机分为 TEE 或 TTE 组。在 TEE 组中，我们使用“停止血流”球囊测量来确定设备尺寸。在 TTE 组中，我们使用平均 ASD 直径乘以 1.2（缩放）。患者随访 1 年。
两组患者的一般和血液动力学特征相似。两组的手术成功率均为 100%。TEE 停止血流直径与缩放 TTE 直径相似（15.35 ± 4.62mm 与 16.57 ± 5.47mm；p = 0.46）。设备尺寸（16.0 ± 4.94mm 与 16.37 ± 5.05mm，p = 0.82）和设备与缺损的比例（1.0 ± 0.06 与 0.99 ± 0.03，p = 0.52）也相似。总手术时间（70.6 ± 22.98min 与 51.1 ± 17.61min，p = 0.005）、房间时间（126.8 ± 28.41min 与 95.7 ± 20.53min，p = 0.0004）和透视时间（13.6 ± 6.17min 与 8.9 ± 8.45min，p = 0.007）在 TTE 组均显著缩短。两组患者在手术过程中和随访中均无明显并发症。两组分流缓解率相似。
本研究表明，在选择的儿科患者中，使用 TTE 评估和指导 ASD 封堵与使用 ASO 进行 TEE 一样有效和安全。TTE 还可能具有降低透视辐射暴露的额外安全益处。
