经胸超声心动图在Amplatzer伞闭合膜部室间隔缺损中的应用探讨

探讨超声引导在应用Amplatzer封堵器治疗先天性心脏病室间隔膜部缺损(Perimembranous ventricular septal defect，PMVSD)中的价值．16例患者，男性9例，女性7例；年龄5～21岁，平均7岁；体重10～64kg，平均35kg．所有病例术前均经临床、心脏超声及心室造影检查确诊为膜部室间隔缺损．缺损的直径3～13mm，合并膜部瘤2例．所有病例心前区均可闻及Ⅱ～Ⅳ级收缩期杂音，心功能Ⅰ～Ⅱ级．在封堵伞的释放前后及术后全部经心脏超声引导和监测Amplatzer伞闭合PMVSD的全过程，监测有无并发症的发生．16例PMVSD患者14例封堵成功，失败2例．所选封堵器的型号为6-16号．成功的14例术中和术后1～7天心脏超声随访无1例残余分流和并发症．失败2例，1例输送鞘穿过VSD缺口后发生Ⅲ度房室传导阻滞被迫结束手术，1例JFR4导管通过缺损口时，刺激主动脉发生低血压和心脏骤停终止手术；失败的2例经积极的对症治疗后，择期心脏外科手术修补成功，无死亡病例．心脏超声在引导和监测Amplatzer伞闭合PMVSD中具有重要的应用价值，完全可以取代经胸超声心动图作为术中的监测．

Role of transthoracic echocardiography in transcatheter closure of perimembranous ventricular septal defect using Amplatzer occluder

The role of transthoracic angiocardiography (TTE) guidance in transcalent closure of perimem-branous ventricular septal defect (PMVSD) using Amplatzer occluder has been investigated. In this study, 16 patients with PMVSD, 9 males, 7 females, with a mean age 7(ranged from 5 to 21) years, mean weight 30 kg(ranged from 20 kg to 64 kg) were studied. All the cases met the condition by transthoracic echocardio-graphy and contrast examination and the diameter of PMVSD was 3.0-13 mm, 2 cases with interventricular septal aneurysm. Under ultrasound guidance and monitoring, PMVSD was lost with Amplatzer occlusion device. Of 16 patients, 14 were treated successfully. No residual shunt was found and no complications observed by TTE immediately, and 1, 3, 5 and 7 days after the procedure. The closure of PMVSD with Amplatzer occlusion device failed in 2 patients. In transcatheter closure of PMVSD using Amplatzer occluder, transthoracic echocardiography played an important role in guiding and monitoring occluder device replacement and the follow-up.