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目的:探讨彩色多普勒超声心动图(CDE)在室间隔缺损(VSD)封堵术中应用价值。方法:应用CDE封堵术前选择适应证,术中监视封堵器释放过程,术后判断封堵术疗效,远期随访。结果:应用CDE选择187例VSD,186例封堵成功,1例封堵器术中脱落,成功率99.5%。术后CDE复查发现2例过室间隔少量残余左向右分流。CDE随访3个月发现1例封堵器移位。CDE选择适应证是:①右室面VSD直径≥2mm,<10mm。②VSD边缘距主动脉瓣≥1mm,轻度以下主动脉瓣关闭不全,无主动脉瓣脱垂。③VSD边缘距三尖瓣隔叶≥2mm,中度以下三尖瓣关闭不全。④并发能介入治疗的畸形,如动脉导管未闭、继发孔房间隔缺损、卵圆孔未闭和肺动脉瓣狭窄。手术中CDE监测封堵器释放过程是:①心尖四腔心切面确定封堵器导管在左心室内。②胸骨旁五腔心切面确定封堵器位于室间隔的左右心室侧的位置,封堵器中间有室间隔回声。③确定封堵器不影响主动脉瓣和三尖瓣功能。④封堵器到位后彩色多普勒血流显像(CDFI)没有显示或显示微量过室间隔分流束血流信号。封堵术后判断疗效:①封堵器不移位。②CDFI没有显示过室间隔分流束血流信号。③主动脉瓣和三尖瓣功能正常。结论:CDE在VSD封堵术中具有重要临床价值,术前选择适应证,术中监视封堵器释放过程,术后判断封堵术疗效,远期随访,其它检查方法不可能与CDE媲美。
Objective: To explore the value of color Doppler echocardiography (CDE) in occlusion of ventricular septal defect (VSD). Methods: CDE was used to select the indications before surgery, and the occlusion of the occluders was monitored intraoperatively. The curative effect of occlusion was evaluated after operation, and the long-term follow-up was performed. Results: 187 cases of VSD were selected by CDE, 186 cases were successfully occluded, 1 case occluded during operation, the success rate was 99.5%. Postoperative CDE review found 2 cases of a small amount of left ventricular septal residual shunt. One case of occluder displacement was found after 3 months follow-up of CDE. CDE selection indications are: ① right ventricular surface VSD diameter ≥ 2mm, <10mm. ②VSD margin from the aortic valve ≥ 1mm, mild aortic insufficiency, no aortic valve prolapse. ③ VSD edge from the tricuspid valve ≥ 2mm, moderate tricuspid regurgitation. ④ concurrent interventional treatment of deformities, such as patent ductus arteriosus, secondary atrial septal defect, patent foramen ovale and pulmonary stenosis. CDE monitoring occluder release process is: ① apical four-chamber heart section to determine the occluder catheter in the left ventricle. ② parasternal five-chamber heart section to determine the occluder located in the left ventricular septal ventricular side of the position, the occlusion of the interventricular septum echo. ③ determine the occluder does not affect the aortic valve and tricuspid valve function. ④ occluder in place after color Doppler flow imaging (CDFI) did not show or show trace micro-ventricular septal flow signal. After the closure of the curative effect: ① occluder does not shift. ②CDFI did not show the interventricular septum flow signal. ③ aortic valve and tricuspid valve function is normal. Conclusion: CDE has important clinical value in the occlusion of VSD. Preoperative selection of indications, intraoperative monitoring of the occlusion device release process, postoperative closure of the curative effect, long-term follow-up, other examination methods can not be comparable with the CDE.