经胸超声心动图在膜周部室间隔缺损介入治疗及中远期随访中的应用

杜亚娟; 张军; 李军; 成革胜; 何璐; 王星烨; 和旭梅; 兰贝蒂; 邵珲; 张玉顺

doi:10.12125/j.chj.202105116

经胸超声心动图在膜周部室间隔缺损介入治疗及中远期随访中的应用

Application of transthoracic echocardiography in interventional treatment and mid-long-term follow-up of perimembranous ventricular septal defect

摘要

摘要:
目的评价经胸超声心动图（TTE）在膜周部室间隔缺损（pmVSD）介入治疗及中远期随访中的应用价值。
方法 TTE诊断pmVSD患者302例(男，129)，年龄（19 ± 16）岁。术前TTE多切面观查缺损的大小、形态、周边结构、心腔的大小等。术中根据TTE及造影结果，选择合适的国产封堵器封堵。术后2 d、6个月、≥12月行TTE检查随访观察封堵效果。所有患者完成≥12月的随访，其中178(58.9%)例完成≥3年随访。
结果 ①术前TTE，pmVSD左室面大小(10.7 ± 4.6, 2.5～26）mm，右室面主孔大小(3.3 ± 1.5, 1.5～11）mm；检出漏斗型121(40.1%)例、囊袋多孔型134(44.3%)例、囊袋单孔型39(12.9%)例、窗型8(2.6%)例；检出右冠瓣、无冠瓣脱垂分别为17(5.6%)例、12(3.9%)例，三尖瓣腱索附着异常34(11.3%)例，其中前瓣附着点距缺损边缘无距离11例(3.6%)；左房、左室明显增大116（38.4%）例；②所有患者均成功封堵，所用封堵器腰部直径(7.3 ± 3.4) mm。③随访结果：术后2 d残余分流31（10.3%）例，术后6个月减少至9（3.0%）例，术后(1～3)年有7（2.3%）例残余分流，术后≥3年有4（2.2%，n = 178）例。所有患者术后新发主动脉瓣返流11例，均为少量，中远期随访无变化；2例患者TR术后由术前少量增加为中量返流，随访1年以上无明显增加，心腔大小正常。术后第二天，93（30.7%）例患者心腔大小回缩正常，术后6个月所有患者心腔大小均回缩至正常。
结论 TTE在pmVSD的介入治疗及中远期随访中具有重要的临床应用价值；经导管pmVSD封堵术安全有效，中远期随访结果良好。

Abstract:
AIM To evaluate the application value of transthoracic echocardiography (TTE) in interventional treatment and mid-long-term follow-up of perimembranous ventricular septal defect (pmVSD).
METHODS A total of 302 patients were diagnosed with pmVSD using TTE, including 129 (42.7%) males and 173 (57.3%) females, with an average age of (19±16) years. The size of the heart cavity, size, shape and peripheral structure of the defect were observed by multi-view TTE before operation. A suitable domestic occluder was selected according to the results of TTE before operation and angiography during the operation. Follow-up was performed on the second day, 6 months and ≥12 months after the operation using TTE to observe the closure effect. All patients completed a follow-up of more than 12 months, and 178 (58.9%) patients completed a follow-up of more than 3 years.
RESULTS TTE identified that pmVSD left ventricular surface size defect was 10.7 ± 4.6 (2.5～26) mm and right ventricular surface size of the main hole 3.3 ± 1.5 (1.5～11) mm before operation. TTE detected 121 (40.1%) cases of funnel type, 134 (44.3%) cases of capsular porous type, 39 (12.9%) cases of capsular single-hole type and 8 (2.6%) cases of window type. There were 17 (5.6%) cases of right coronary valve prolapsed, 12 (3.9%) cases of non coronary valve prolapsed and 34 (11.3%) cases of abnormal attachment of tricuspid chordae tendineae. There were 34 (11.3%) cases with abnormal tricuspid chordal attachment and 11 cases (3.6%) had a distance of 0 mm from the anterior valve attachment point to the edge of the defect. There were 116 cases (38.4%) with enlarged left atrium and ventricle. All patients were successfully occluded and the waist diameters of the occluder used were (7.3±3)4 mm. After operation, there were 31 (10.3%) cases of residual shunt on the second day, which decreased to 9 (3.0%) cases at 6 months, 7 (2.3%) cases in 1～3 years and 4 (2.2%, n = 178) cases≥3 years. Eleven cases had new onset of aortic regurgitation after operation, all of which were small and there was no change in the medium and long-term follow-up. Two patients with tricuspid regurgitation increased from small regurgitation before operation to moderate regurgitation after operation, and there was no significant increase when they were followed up for more than 1 year and their heart cavity size was normal. Ninety-three (30.7%) patients presented normal cardiac cavity size on the second day after operation, and all patients had normal cardiac cavity size 6 months after operation.
CONCLUSION TTE has important clinical value in the interventional treatment and long-term follow-up of pmVSD. Transcatheter closure of pmVSD is safe and effective, with favorable results in mid-long-term follow-up.

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