Department of Echocardiography, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, China.
CardiMed Medical Technology, Shanghai, 200000, China.
Int J Cardiovasc Imaging. 2021 Jan;37(1):117-124. doi: 10.1007/s10554-020-01967-6. Epub 2020 Aug 14.
The purpose of this study was to assess the value of echocardiography for intraoperative guidance during closure of perimembranous ventricular septal defects (pmVSD) and to assess outcomes of these patients. We identified and assessed 78 patients who underwent 2- and 3-dimensional echocardiography-guided mini-invasive per-atrial closure of pmVSD in the cardiac surgery department of our institution, from February 2016 to August 2018, and 76 patients who underwent transcatheter closure of VSD guided by fluoroscopy at the pediatric department (percutaneous control group). All the patients underwent echocardiography. Their clinical data were retrospectively reviewed and analyzed. All patients were followed up using transthoracic echocardiography (TTE) for a maximum of 24 months after the closure. All patients underwent successful device implantation. Echocardiography showed that the major immediate complications included residual shunt, pericardial effusion, and tricuspid regurgitation in the per-atrial group. During the mid-term follow-up period, TTE revealed that the most common complication was tricuspid regurgitation (non-preexisting). There were no cases of VSD recurrence, device displacement, valvular injury, malignant arrhythmias, hemolysis, or death. Moreover, according to the TTE data, the intracardiac structure of the patients were improved. Compared to the control group, the intracardiac manipulation time was shorter and the number of patients with residual shunts, redeployment of devices, or immediate new tricuspid regurgitations was fewer when using 2- and 3-dimensional echocardiography. However, the procedure time in the per-atrial group was slightly longer than that in the control group. Two- and 3-dimensional echocardiography are feasible monitoring tools during mini-invasive per-atrial VSD closure. The short- and mid-term follow-up showed satisfactory results compared to fluoroscopy.
本研究旨在评估超声心动图在经心房微创膜周室间隔缺损（pmVSD）封堵术中的指导价值，并评估这些患者的结局。我们在我院心脏外科部门，从 2016 年 2 月至 2018 年 8 月，识别并评估了 78 例行 2 维和 3 维超声心动图引导下微创经心房 pmVSD 封堵术的患者，以及在儿科部门行经导管封堵室间隔缺损（透视对照组）的 76 例患者。所有患者均接受了超声心动图检查。回顾性分析了他们的临床资料。所有患者均接受了经胸超声心动图（TTE）随访，最长随访时间为封堵后 24 个月。所有患者均成功植入了封堵器。超声心动图显示，经心房组的主要即刻并发症包括残余分流、心包积液和三尖瓣反流。在中期随访期间，TTE 显示最常见的并发症是三尖瓣反流（非原有）。无 VSD 复发、器械移位、瓣膜损伤、恶性心律失常、溶血或死亡病例。此外，根据 TTE 数据，患者的心脏内结构得到改善。与对照组相比，在经心房组中，使用 2 维和 3 维超声心动图时，心内操作时间更短，残余分流、器械重新部署或即刻新发三尖瓣反流的患者更少。然而，经心房组的手术时间略长于对照组。2 维和 3 维超声心动图是微创经心房 VSD 封堵术的可行监测工具。短期和中期随访结果与透视相比令人满意。
