切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (02) : 150 -152. doi: 10.3877/cma.j.issn.1672-6448.2020.02.011

所属专题: 文献

心血管超声影像学

心外膜超声心动图在肌部室间隔缺损镶嵌治疗中的应用价值
卢绪宁1, 文平1,(), 刘宇航1, 刘启龙1, 刘大为1, 崔琳1, 朱全伟1, 王宁1   
  1. 1. 116012 大连医科大学附属大连市儿童医院心脏中心
  • 收稿日期:2019-05-28 出版日期:2020-02-22
  • 通信作者: 文平

Application value of intraoperative epicardial echocardiography in hybrid approach to perventricular device closure of muscular ventricular septal defect

Xuning Lu1, Ping Wen1,(), Yuhang Liu1, Qilong Liu1, Dawei Liu1, Lin Cui1, Quanwei Zhu1, Ning Wang1   

  1. 1. Heart Center, Children′s Hospital of Dalian Medical University, Dalian 116012, China
  • Received:2019-05-28 Published:2020-02-22
  • Corresponding author: Ping Wen
  • About author:
    Corresponding author: Wen Ping, Email:
引用本文:

卢绪宁, 文平, 刘宇航, 刘启龙, 刘大为, 崔琳, 朱全伟, 王宁. 心外膜超声心动图在肌部室间隔缺损镶嵌治疗中的应用价值[J]. 中华医学超声杂志(电子版), 2020, 17(02): 150-152.

Xuning Lu, Ping Wen, Yuhang Liu, Qilong Liu, Dawei Liu, Lin Cui, Quanwei Zhu, Ning Wang. Application value of intraoperative epicardial echocardiography in hybrid approach to perventricular device closure of muscular ventricular septal defect[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(02): 150-152.

目的

探讨心外膜超声心动图(IEE)在肌部室间隔缺损(mVSD)镶嵌治疗中的应用价值。

方法

选取2014年1月至2018年3月就诊于大连医科大学附属大连市儿童医院,经胸超声心动图(TTE)诊断为单纯mVSD的患儿8例。所有患儿均在IEE引导下完成经胸mVSD镶嵌封堵治疗,并于术后即刻评价封堵效果,术后1、3、6、12个月定期复查TTE、心电图、尿常规,观察封堵器有无移位、脱落,有无心律失常及溶血等并发症发生。

结果

8例患儿均在IEE引导下经胸镶嵌封堵成功,其中1例存在残余分流。术后1、3、6、12个月随访,封堵器均无脱落及移位,无心律失常及溶血发生,残余分流患儿在术后6个月复查时残余分流消失。

结论

IEE引导镶嵌治疗mVSD具有清晰显示mVSD全貌、准确引导镶嵌治疗过程、受操作位置和角度限制较小、无辐射、无需造影剂、创伤相对较小(避免体外循环)等优势,在mVSD镶嵌治疗中具有良好的临床应用价值。

Objective

To evaluate the application value of intraoperative epicardial echocardiography (IEE) in the hybrid approach to perventricular device closure of muscular ventricular septal defect (mVSD).

Methods

Eight patients were diagnosed with isolated mVSD by preoperative transthoracic echocardiography (TTE) at the Heart Center of Children′s Hospital of Dalian Medical University from January 2014 to March 2018. All patients with mVSD were closed via the hybrid approach under IEE guidance with specific devices. The effects of the procedure was evaluated by IEE. Follow-up study was performed at 1 month, 3 months, 6 months, and 12 months after operation by TTE, electrocardiogram, and routine urine tests to observe whether complications such as sealing device migration or loss, arrhythmia, and hemolysis occurred.

Results

All cases were occluded successfully via the hybrid approach under IEE guidance with specific devices, and one case had residual shunt less than 2 mm, which disappeared 6 months after surgery. All patients underwent TTE, electrocardiogram, and routine urine tests at 1 month, 3 months, 6 months, and 12 months after operation, and no notable residual shunt, occluderloss or migration, or arrhythmia was found.

Conclusion

IEE has a high value in the hybrid approach closure of mVSD, and the image of mVSD by IEE is clearer than that by transesophageal echocardiography (TEE). IEE is easy to operate, and avoids the use of cardiopulmonary bypass, radiation, and contrast agents.

图1 心外膜超声心动图引导下镶嵌治疗关闭肌部室间隔缺损。图a为输送鞘管通过肌部室间隔缺损(箭头所示为输送鞘管);图b为释放封堵器左心室侧伞盘(箭头所示为左心室侧封堵器伞盘);图c为释放封堵器右心室侧伞盘(箭头所示为右心室侧封堵器伞盘)
1
刘延玲,熊鉴然. 临床超声心动图学 [M]. 2版. 北京: 科学技术出版社, 2007: 361.
2
Seddio F, Reddy VM, McElhinney DB, et al. Multiple ventricular septal defects:How and when should they be repaired ? [J]. J Thorac Cardiovasc Surg, 1999, 117(1): 39-40.
3
Kitagawa T, Durham LA, Mosca RS, et al. Techniquesand results in the management of multiple ventricular septal defects [J]. J ThoracCardiovascSurg, 1998, 115(4): 848-856.
4
Vitiello R, McCrindle BW, Nykanen D, et al. Complications associated with pediatric cardiac catheterization [J]. J Am CollCardiol, 1998, 32(5): 1433-1440.
5
Ozturk E, Cansaran Tanidir I, Ayyildiz P, et al. The role of intraoperative epicardial echocardiography in pediatric cardiac surgery [J]. Echocardiography, 2018, 35(7): 999-1004.
6
Ayyildiz P, Güzeltas A, Tanidir IC, et al. Transesophageal echocardiography experience in the pediatric agegroup in a tertiary cardiac center [J]. Turk J Med Sci, 2016, 46(4): 1155-1161.
7
陈俊,左维嵩,莫绪明, 等. 经食管超声心动图在体外循环下小儿肌部室间隔缺损镶嵌治疗中的应用 [J]. 中华超声影像学杂志, 2012, 21(3): 189-192.
8
卢绪宁,文平,刘启龙, 等. 单纯食管超声引导下经股静脉行动脉导管未闭封堵术的安全性和有效 [J]. 中华实用儿科临床杂志, 2017, 32(1): 41-43.
9
唐红,白文娟,安琪, 等. 经食管超声心动图在经胸微创房间隔和室间隔缺损封堵术中的应用 [J]. 中华超声影像学杂志, 2008, 17(7): 557-559.
10
Stern KWD, Gauvreau K, Emani S, et al. Utility of a standardizepos-tcardiopulmonary bypass epicardialechocardiographyprotocol for stage I Norwood palliation [J]. Congenit Heart Dis, 2017, 12(3): 350-356.
11
Jijeh AMZ, Omran AS, Najm HK, et al. Role of intraoperative-transesophageal echocardiography in pediatric cardiacsurgery [J]. J Saudi Heart Assoc, 2016, 28(2): 89-94.
12
Manvi VF, Dixit M, Srinivas K, et al. Accuracy of intraoperative epicardial echocardiography in the assessmentof surgical repair of congenital heart defects confirmed [J]. J Cardiovasc Echogr, 2013, 23(2): 60-65.
13
Dragulescu A, Golding F, Van Arsdell G, et al. The impact of additional epicardial imaging totransesophagealechocardiography on intraoperative detection ofresiduallesions in congenital heart surgery [J]. J Thorac Cardiovasc Surg, 2012, 143(2): 361-367.
[1] 张婉微, 秦芸芸, 蔡绮哲, 林明明, 田润雨, 金姗, 吕秀章. 心肌收缩早期延长对非ST段抬高型急性冠脉综合征患者冠状动脉严重狭窄的预测价值[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1016-1022.
[2] 任书堂, 刘晓程, 张亚东, 孙佳英, 陈萍, 周建华, 龙进, 黄云洲. 左心室辅助装置支持下单纯收缩期主动脉瓣反流的超声心动图特征[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1023-1028.
[3] 孙佳英, 黄云洲, 任书堂, 王翠华, 陈新华, 于艾嘉, 陈元禄. 无创心肌做功对左束支传导阻滞患者左心室整体及节段心肌收缩功能的评价[J]. 中华医学超声杂志(电子版), 2023, 20(08): 836-843.
[4] 钟露, 曹省, 宋宏宁, 陈金玲, 周青. 超声心动图定量评估二尖瓣反流程度的质量控制[J]. 中华医学超声杂志(电子版), 2023, 20(07): 705-711.
[5] 金姗, 丁雪晏, 蔡绮哲, 李一丹, 赵智玲, 郭兮恒, 吕秀章. 左心室压力-应变环对阻塞型睡眠呼吸暂停综合征患者心肌功能的评价[J]. 中华医学超声杂志(电子版), 2023, 20(06): 575-580.
[6] 刘婷婷, 丁明岩, 冀威, 郭丽娟, 李颖, 赵含章, 朱芳. 非冠状动脉梗阻性缺血性心脏病女性患者心率储备与微循环功能障碍的相关性研究[J]. 中华医学超声杂志(电子版), 2022, 19(10): 1077-1082.
[7] 张贺彬, 高枫, 郑哲岚, 王晓嫚, 陈丽, 杨寸芯, 胡佩佩. 二维斑点追踪超声心动图对业余马拉松运动员右心室收缩功能的评估[J]. 中华医学超声杂志(电子版), 2022, 19(10): 1091-1097.
[8] 钟春燕, 董虹美, 张晓航, 冉素真. 胎儿永存左上腔静脉合并肺/主动脉和右/左心室比例异常的产前超声诊断及预后分析[J]. 中华医学超声杂志(电子版), 2022, 19(09): 933-940.
[9] 杨喆, 尹立雪, 王斯佳, 罗素秋, 赵欣, 周乔, 苏江, 邬锐. 超声血流向量成像对痛风患者左心室能量损耗的初步评价[J]. 中华医学超声杂志(电子版), 2022, 19(06): 527-534.
[10] 张红梅, 李春梅, 王胰, 张清凤, 丁戈琦, 邓燕, 林薿, 李文华, 尹立雪. 经胸右心声学造影不同右心房增压方式评估卵圆孔未闭隐匿性右向左分流的价值[J]. 中华医学超声杂志(电子版), 2022, 19(06): 508-513.
[11] 张伟, 王莉, 安彩霞, 王俭勤. 不同辐射防护措施对降低儿童先天性心脏病介入诊疗过程中辐射剂量的应用价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 455-463.
[12] 陈樱, 陈艳莉. 高龄孕妇心率变异性原因及围产结局分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 295-301.
[13] 张雯, 徐宏燕, 张彦春, 刘凯波. 2017—2021年北京市先天性心脏病流行病学资料分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(01): 61-68.
[14] 江岚, 梁伟翔, 苏春宏, 苏志源, 刘丹丹, 戴丽, 陈敦金. 超声心动图评估妊娠合并严重心脏病患者剖宫产围术期心容量及功能的变化特征[J]. 中华产科急救电子杂志, 2023, 12(01): 28-35.
[15] 李燕伟, 黄大军, 伍洲, 张嬿, 康彧, 孔令秋. 曲折的右心声学造影一例[J]. 中华心脏与心律电子杂志, 2023, 11(03): 179-181.
阅读次数
全文


摘要