Jian Wen-Yen, Lin Su-Man, Tsai Shen-Kou, Hwang Betau
Pediatric Cardiology, Heart center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 May 1;84(5):550-554. doi: 10.1097/JCMA.0000000000000524.
Transthoracic echocardiography (TTE) is noninvasive but can only be performed intermittently during fluoroscopy. In a prior study, we created a transducer holder device to allow for hemodynamic monitoring in the intensive care unit. The current study is the first instance of the use of a three-dimensional (3D)-printed TTE transducer holder, which is easily customized and personalized to a previous transducer holder at relatively low cost and short production time, to enable continuous TTE monitoring during device closure of an atrial septal defect (ASD) and ventricular septal defect (VSD). There were 14 ASD patients and 9 VSD patients scheduled to undergo device closure. The study's real-time TTE monitoring was performed by using a 3D-printed transducer holder over the course of the entire implantation procedure. There were 23 patients who successfully underwent septal closures using the 3D-printed holder that enabled real-time images over the entire procedure. The median duration for real-time TTE guidance was 15 minutes for the ASD and 36 minutes for the VSD and the median fluoroscopy time was 11 minutes for the ASD and 30 minutes for the VSD. One migrating VSD occluder and one case of aortic regurgitation after occluder deployment were noted by real-time TTE monitoring during the procedure. Our novel 3D-printed transducer holder can provide transesophageal echocardiography-like real-time imaging during device closure of an ASD and a VSD and may become a new alternative method in ASD and VSD closures. It can also prevent radiation exposure for the intervention team who would otherwise need to perform TTE during live fluoroscopy.
经胸超声心动图（TTE）是非侵入性的，但只能在荧光透视期间间歇性地进行。在先前的一项研究中，我们制作了一种换能器固定装置，以便在重症监护病房进行血流动力学监测。本研究首次使用了三维（3D）打印的TTE换能器固定装置，该装置易于定制且能以相对较低的成本和较短的生产时间根据先前的换能器固定装置进行个性化定制，从而在房间隔缺损（ASD）和室间隔缺损（VSD）封堵装置的过程中实现TTE连续监测。有14例ASD患者和9例VSD患者计划接受封堵装置治疗。该研究的实时TTE监测是在整个植入过程中使用3D打印的换能器固定装置进行的。有23例患者使用3D打印的固定装置成功进行了间隔封堵，该装置在整个过程中都能提供实时图像。ASD实时TTE引导的中位持续时间为15分钟，VSD为36分钟，ASD荧光透视的中位时间为11分钟，VSD为30分钟。在手术过程中，实时TTE监测发现1例VSD封堵器移位和1例封堵器置入后主动脉瓣反流病例。我们新型的3D打印换能器固定装置可以在ASD和VSD封堵装置过程中提供类似经食管超声心动图的实时成像，可能成为ASD和VSD封堵的一种新的替代方法。它还可以避免介入团队在实时荧光透视期间进行TTE时受到辐射暴露。
