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目的研究经胸超声心动图(TTE)在继发孔型房间隔缺损(ASD)介入治疗的病例筛选及封堵器选择方面的应用价值。方法回顾分析2002-03—2006-03于山东大学山东省立医院小儿心脏科行介入治疗的54例继发孔型ASD患儿,统计其术前TTE所测的ASD的形态、大小、边缘情况等,对术前TTE测得的ASD最大径、X线测得的球囊腰径及TTE测得的球囊径分别与所用封堵器型号大小进行统计学分析比较,并进行TTE测得的ASD最大径与封堵器型号大小的相关性分析,计算回归方程。结果54例均成功封堵,手术时间20~145(57.64±24.89)min,曝光时间3.1~31.5(9.22±7.41)min,住院天数3~10(5.74±1.72)d。其中有15例患儿存在ASD单一边缘不够标准,均封堵成功。术前TTE测得的ASD最大径[4~33mm,(16.31±7.34)mm]、术中X线测球囊腰径[6.7~28mm,(19.80±7.24)mm]及TTE测球囊径[9.6~24.8mm,(19.92±6.38)mm]与封堵器大小[5~36mm,(18.85±7.89)mm]差异均无显著性意义(P>0.05)。且术前TTE测得的ASD最大径与封堵器型号有良好的线性相关(r=0.945,P<0.05),计算回归方程为封堵器型号=1.015×(TTE测得的ASD最大径)+2.3mm。结论TTE的应用,使ASD介入治疗病例的筛选得到了保证。作为一种无创性影像学诊断方法,对ASD封堵器选择的评估有重要的应用价值。
Objective To investigate the value of transthoracic echocardiography (TTE) in the screening of patients with secondary atrial septal defect (ASD) and the selection of occluders. Methods A retrospective analysis of 2002-03-2006-03 in Shandong Provincial Hospital of Shandong Province Pediatric Cardiology interventional treatment of 54 cases of children with secondary pass ASD, statistics preoperative TTE measured ASD morphology, size, marginal conditions And so on, preoperative TTE measured maximum diameter of ASD, X-ray measured balloon waist diameter and TTE balloon diameter were compared with the type of occluder model used for statistical analysis and comparison, and TTE measured ASD maximum diameter and occluder model size of the correlation analysis, calculate the regression equation. Results All the 54 cases were successfully occluded. The operation time ranged from 20 to 145 (57.64 ± 24.89) min, the exposure time ranged from 3.1 to 31.5 (9.22 ± 7.41) min, and the length of stay from 3 to 10 (5.74 ± 1.72) days. Among them, 15 cases of children with ASD single edge not enough standards, were blocked successfully. The maximum ASD diameter [4 ~ 33mm, (16.31 ± 7.34) mm], intraoperative X-ray measurement of waist diameter [6.7-28 mm (19.80 ± 7.24) mm] and TTE measured by preoperative TTE [ 9.6 ~ 24.8mm, (19.92 ± 6.38) mm] and occluder size [5 ~ 36mm, (18.85 ± 7.89) mm] respectively. There was no significant difference between the two groups (P> 0.05). There was a good linear correlation between the maximum diameter of ASD measured by TTE and occluder type (r = 0.945, P <0.05). The regression equation was calculated as occluder type = 1.015 × (the maximum diameter of ASD measured by TTE) + 2.3mm. Conclusions The application of TTE has ensured the screening of ASD interventional therapy cases. As a noninvasive imaging diagnostic method, the evaluation of ASD occluder selection has important application value.