经食道实时三维超声心动图在房间隔缺损封堵术中的应用

发布时间：2019-02-25 19:52

【摘要】：背景房间隔缺损(ASD)系房间隔在发育过程中出现异常,致使其发育不完整,在左房和右房之间出现缺损,是临床上最常见的先天性心脏病之一,发病率常居第二位。由于长期心房水平的左向右分流,部分左心房血液经ASD进入右心房,反复通过肺循环,使左心房、右心房及右心室容量负荷增加,主要引起右心房和右心室扩张、心室壁增厚,进而导致右室容量负荷过重,随右心容量负荷不断增加,最终将导致慢性右心衰竭。以前外科修补术是ASD的主要治疗手段,近年来随着随着介入技术日益成熟,越来越多的ASD患者可以通过介入手术进行治疗,减少了手术创伤,减轻了患者的痛苦,缩短了住院时间,介入封堵治疗房间隔缺损以其突出的优势逐渐成为微创治疗ASD的首选方法。然而并不是所有ASD都可以运用介入封堵治疗,缺损要有符合封堵的条件,这就要求术前必须明确缺损的大小、位置、数量、残边等基本情况,如今随着超声技术的不断发展,经食道实时三维超声心动图的出现是超声技术领域的又一历史性突破,它实际上是胃镜技术与超声检查结合的产物,采用胃镜检查方法将超声探头插入受检者试管内,由于不受胸廓、肺部疾病的影响,离心脏较近,故可清晰地显示心内组织结构,及其相对空间位置,本研究主要探讨经食道实时三维超声心动图在房间隔缺损介入封堵术中的临床应用价值。目的评价经食道实时三维超声心动图在II孔型房间隔缺损(ASD)封堵器型号选择中的临床应用价值。方法62例先心病单纯II孔型房间隔缺损(ASD)患者,术前均行二维经胸超声(2D-T TE)、二维经食道超声(2D-TEE)检查测量ASD最大径及实时三维经食道超声(RT-3D-TEE)检查测量ASD最大直径及面积。将所得测结果与房间隔缺损封堵器(ASO)型号作对比。结果60例患者成功接受经导管房间隔缺损封堵术(TCASD)治疗,术后均未探及残余分流,1例因经食道实时三维超声诊断为多孔型房缺而放弃封堵,1例因上腔静脉侧残边缺如放弃封堵。RT-3D-TEE、2D-TEE和2D-TTE的ASD最大径与ASO型号相关良好(r=0.881、0.798、0.702),RT-3D-TEE测量面积与ASO型号相关性系数为0.912,最大径的相关性RT-3D-TEE测量的最高,同时运用RT-3D-TEE测量面积和封堵器型号的相关性比此三种方法测量ASD最大径的相关性高。结论实时经食道三维超声心动图像可为房间隔缺损提供更准确的诊断信息,能较精确地测量出房间隔缺损的面积和最大径,在房缺封堵中能为封堵器型号的选择提供可靠的参考。
[Abstract]:Background Atrial septal defect (ASD) is one of the most common congenital heart diseases, which is usually the second most common congenital heart disease, due to the abnormal development of atrial septum, which leads to incomplete development and the defect between left atrium and right atrium. As a result of long-term left-to-right shunt at the atrial level, some left atrial blood enters the right atrium through ASD and repeatedly passes through the pulmonary circulation, resulting in an increase in the volume load of the left atrium, the right atrium and the right ventricle, mainly resulting in the expansion of the right atrium and the right ventricle, and the thickening of the ventricular wall. As a result, the right ventricular capacity is overloaded. With the increasing of the right ventricular capacity load, chronic right ventricular failure will eventually be caused. In recent years, with the increasing maturity of interventional technology, more and more ASD patients can be treated by interventional surgery, reducing the surgical trauma and alleviating the pain of ASD. Interventional closure of atrial septal defect (ASD) has become the first choice for minimally invasive treatment of ASD due to its outstanding advantages. However, not all ASD can be treated by interventional closure, and the defect should meet the requirements of closure. This requires that the size, location, quantity and residual edge of the defect should be clearly defined before the operation. Nowadays, with the continuous development of ultrasound technology, it is necessary to determine the size, location, quantity and residual edge of the defect. The appearance of transesophageal real-time three-dimensional echocardiography is another historic breakthrough in the field of ultrasound technology. In fact, it is the product of the combination of gastroscopy and ultrasound examination. The ultrasound probe is inserted into the test tube of the subjects by the method of gastroscopy. Because it is not affected by chest and lung diseases and is closer to the heart, it can clearly show the structure of the heart tissue and its relative spatial position. The purpose of this study was to evaluate the clinical value of transesophageal real-time three-dimensional echocardiography in transesophageal transcatheter closure of atrial septal defect (ASD). Objective to evaluate the clinical value of transesophageal real-time three-dimensional echocardiography in selecting the type of (ASD) occluder for II hole atrial septal defect (ASD). Methods 62 patients with congenital heart disease (CHD) with simple II hole atrial septal defect (ASD) underwent two-dimensional transthoracic ultrasound (2D-T TE),) before operation. Two-dimensional transesophageal ultrasound (2D-TEE) was used to measure the maximum diameter of ASD and three-dimensional real-time transesophageal ultrasound (RT-3D-TEE) was used to measure the maximum diameter and area of ASD. The results were compared with the type of atrial septal defect occluder (ASO). Results 60 patients were successfully treated with transcatheter closure of atrial septal defect (TCASD). No residual shunt was detected after operation. One patient gave up closure due to transesophageal real-time three-dimensional ultrasound diagnosis of perforated atrial septal defect. RT-3D test showed that the maximum diameter of ASD of 2D tee and 2D-TTE was correlated well with ASO type (r = 0.881, 0.798, 0.702). The correlation coefficient between RT-3D-TEE measured area and ASO type was 0.912, and the correlation coefficient was 0.912 between the measured area of RT-3D-TEE and the ASO type (r = 0.881, 0.798, 0.702). The correlation of the maximum diameter measured by RT-3D-TEE is the highest, and the correlation between the area measured by RT-3D-TEE and the type of occluder is higher than the correlation of the three methods for measuring the maximum diameter of ASD. Conclusion Real-time transesophageal three-dimensional echocardiography can provide more accurate information for the diagnosis of atrial septal defect and can accurately measure the area and maximum diameter of atrial septal defect. It can provide reliable reference for the selection of occluder model in the closure of atrial defect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.1

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