探讨经食管超声心动图（TEE）联合经胸超声心动图（TTE）在单纯性继发孔型房间隔缺损（ASD）患者微创外科治疗术前筛查、术中引导及术后随访中的应用价值。

选取2013年1月至2014年12月郑州大学第一附属医院收治的单纯性继发孔型ASD患者130例。所有患者均于TEE引导下进行微创外科封堵治疗。术前采用TTE筛选合适病例；麻醉状态下采用TEE再次评估ASD大小以选择合适的封堵器型号，引导封堵器放置，同时实时动态评估封堵效果；术后3 d、3个月、6个月、1年采用TTE评价心内结构及功能。

130例单纯性继发孔型ASD患者中119例封堵成功，成功率为91.5%（119/130）。其中34例（26.0%，34/130）主动脉后壁对侧残边短小ASD患者中33例封堵成功；27例（20.6%，27/130）房室瓣侧残边短小ASD患者均封堵成功；12例（9.1%，12/130）心房后顶部侧残边短小ASD患者均封堵成功；14例（10.8%，14/130）后下缘残边短小ASD患者中6例封堵成功；6例（4.6%，6/130）双孔或筛孔型ASD患者中4例封堵成功；其余37例（28.5%，37/130）周围残边≥5 mm的ASD患者全部封堵成功。11例封堵不成功的ASD患者均改行体外循环辅助下心内直视修补术，其中后下缘残边≤4 mm者8例，主动脉后壁对侧残边短小者1例，筛孔型ASD 1例，双孔型ASD 1例，且两孔间距离>8 mm。术后3 d、3个月、6个月、1年随访，119例封堵成功ASD患者均无房室阻滞、残余分流、瓣膜损伤及封堵器脱落发生。

超声心动图对经胸外科微创封堵术治疗ASD患者有重要且可靠的作用，尤其是残边短小难堵型ASD患者。

To study the application value of transeaophageal echocardiography (TEE) combinated transthoracic echocardiography (TTE) in preoperative screening,intraooperative guidance and postoperative follow-up of minimally invasive isolated secundum atrial septal defect (ASD) closure.

Totally 130 cases of isolated secundum atrial defects were treated by minimal invasive surgical device closure in The First Affiliated Hospital of Zhengzhou University from January 2013 to December 2014. Before the surgery, transthoracic echocardiaography was applied for screening; during the surgery we reassessed the sizes of the defects and their remaining margins, designated the suitable occluders, and guided the placement of the occludes, real-time dynamic evaluation of the effect by TEE. After 3 d, 3 months, 6 months, 1 year, the patients were postoperatively followed up at regular intervals by TTE which was employed to assess the therapeutic efficacy. Included the cardiac structure and function, synchronous detection, electrocardiogram, blood and urine routine.

Among the 130 cases of isolated atrial septal defect, 119 cases were successfully closed, the success rate is 91.5% (119/130). Among the 120 successful cases, 33 were cases (26.0%, 34/130) with short residue margin in opposite side of aortic posterior wall of ASD, all 27 cases (20.6%, 27/130) with short atrioventricular valve side margin of ASD were successfully closed, all 12 cases (9.1%, 12/130) with short posterior-tope of atrial margin of ASD were successfully closed, 6 cases were successfully closed among the 14 cases (10.8%, 14/130) with short posterior-inferior margin of ASD, 4 cases were successfully closed among the 6 cases (4.6%, 6/130) with mesh-type or double ASD, the remaining 37 cases (28.5%, 37/130) were successfully closed, which residul rims around the ASD were ≥ 5 mm. Eleven cases were repaired by intracardiac repairing under direct vision with the assistance of extracorporeal circulation, included 8 cases with short posterior-inferior margin of ASD, 1 case with short residue margin in opposite side of aortic posterior wall of ASD, 1 case of mesh-type ASD and 1 case of double ASD, the distance between two adjacent holes is >8 mm. With 1 year′s follow up, 119 successfully closed cases showed the firmly occlusion, there were no notable residual shunt, atrioventricular block, valve damaged, occluder-loss or valve regurgitation.

Echocardiography plays vital and reliable role in minimal-invasive surgical device closure of secundum atrial septal defects, especially in those with special and difficultly-occluded defects.