Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
J Card Surg. 2022 May;37(5):1171-1179. doi: 10.1111/jocs.16311. Epub 2022 Feb 21.
To investigate the value of transesophageal echocardiography (TEE) in perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children.
From January 2015 to December 2020, 212 children with PmVSDs underwent device occlusion via an ultra-minimal trans intercostal incision. TEE was used throughout the perioperative period, including TEE assessment, TEE-guided localization of the puncture site, and TEE guidance. All patients were followed up using transthoracic echocardiography for more than 6 months.
A total of 207 cases were successfully occluded, and the success rate was 97.64%. One hundred forty-five patients had a single orifice, and 62 patients had multiple orifices in the aneurysm of the membranous septum (AMS). During the operation, the surgeon readjusted the device or replaced it with a larger device in 17 cases. After the operation, 19 cases of a slight residual shunt, 13 cases of pericardial effusion, and 4 cases of pleural effusion were noted. All patients returned to normal during the 4-month follow-up period. Mild mitral regurgitation was present in one patient and remained the same during the follow-up period. No other complications were found.
Under TEE guidance, PmVSDs were closed successfully using a concentric occluder via an ultra-minimal trans intercostal incision. TEE, which was used to assess defects and postoperative effect, effectively guide PmVSDs closure, is of great value.
探讨经胸超声心动图（TEE）在经左胸骨旁超微创肋间切口行膜周部室间隔缺损（PmVSD）封堵术中的应用价值。
2015 年 1 月至 2020 年 12 月，212 例 PmVSD 患儿经超微创肋间切口行封堵器封堵术。围手术期均采用 TEE 评估、TEE 引导穿刺点定位及 TEE 引导。所有患者均经胸超声心动图随访 6 个月以上。
共 207 例成功封堵，成功率为 97.64%。145 例为单孔，62 例为膜部瘤（AMS）多发性孔。术中，术者调整封堵器 17 例，更换大一号封堵器 1 例。术后，轻微残余分流 19 例，心包积液 13 例，胸腔积液 4 例。所有患者均在 4 个月的随访期内恢复正常。1 例轻度二尖瓣反流，随访期间无变化。无其他并发症发生。
在 TEE 引导下，采用同心封堵器经超微创肋间切口成功封堵 PmVSD。TEE 用于评估缺损和术后效果，可有效指导 PmVSD 封堵，具有重要价值。
