CAJ | 학술논문

目的：探讨超声心动图在外科微创封堵治疗房间隔缺损（ASD）中的应用价值。方法术前经胸超声心动图（TTE）筛选单纯继发孔中央型ASD 20例，术中经食管超声心动图（TEE）进一步评估引导外科微创封堵治疗，术后7 d、3～6月TTE 随访。结果20例患者行ASD外科微创封堵术，封堵成功20例，占100％。TEE与TTE对ASD最大径测量值差异无统计学意义（P＞0．05）。术后7 d、3～6个月TTE随访，封堵器位置固定，未见移位，对周围瓣膜功能及静脉回流无影响，2例有微量残余分流；右心重构改善，右房、右室大小较术前缩小，肺动脉血流速度降低。结论超声心动图参与了外科微创封堵治疗ASD的全过程，TEE与TTE联合应用，对术前诊断与筛选、术中选择封堵器和实时监控、术后效果评价具有不可或缺的重要作用。
목적：탐토초성심동도재외과미창봉도치료방간격결손（ASD）중적응용개치。방법술전경흉초성심동도（TTE）사선단순계발공중앙형ASD 20례，술중경식관초성심동도（TEE）진일보평고인도외과미창봉도치료，술후7 d、3～6월TTE 수방。결과20례환자행ASD외과미창봉도술，봉도성공20례，점100％。TEE여TTE대ASD최대경측량치차이무통계학의의（P＞0．05）。술후7 d、3～6개월TTE수방，봉도기위치고정，미견이위，대주위판막공능급정맥회류무영향，2례유미량잔여분류；우심중구개선，우방、우실대소교술전축소，폐동맥혈류속도강저。결론초성심동도삼여료외과미창봉도치료ASD적전과정，TEE여TTE연합응용，대술전진단여사선、술중선택봉도기화실시감공、술후효과평개구유불가혹결적중요작용。
Objective To assess the application value of echocardiography in minimally invasive surgical closure of secondary atrial septal defect(ASD).Methods Twenty patients with isolated secundum central ASD were included based on preoperative TTE results, and received minimally invasive surgical closure under simultaneous assessment and guidance of intraoperative TEE.All patients were followed up for severn days,3 to 6 months using TTE.Results TEE guided minimally invasive surgical closure was successful in twen-ty patients (100%).The maximum diameter of ASD measured by TEE and TTE were no significantly different(P>0.05).During sev-ern days,3 to 6 months follow-up,occluder was well fixed and didn’t affect the function of atrial-ventricular valves and venous return, two patients were found with trace residual shunt.The remodeling of right atrium and right ventricle was reversed with decreased dimen-sion,and the pulmonary artery flow velocity was significantly reduced after surgery.Conclusion In our study,echocardiography was performed through out the course of minimally invasive surgical closure of ASD.Combined application of TEE and TTE was effective in providing preoperative diagnosis and screening for eligible patients,intraoperative guidance for the selection of appropriate occluder and real-time monitoring,as well as evaluation during postoperative follow-up.