【摘要】：背景房間隔缺損(ASD)系房間隔在發(fā)育過(guò)程中出現(xiàn)異常,致使其發(fā)育不完整,在左房和右房之間出現(xiàn)缺損,是臨床上最常見(jiàn)的先天性心臟病之一,發(fā)病率常居第二位。由于長(zhǎng)期心房水平的左向右分流,部分左心房血液經(jīng)ASD進(jìn)入右心房,反復(fù)通過(guò)肺循環(huán),使左心房、右心房及右心室容量負(fù)荷增加,主要引起右心房和右心室擴(kuò)張、心室壁增厚,進(jìn)而導(dǎo)致右室容量負(fù)荷過(guò)重,隨右心容量負(fù)荷不斷增加,最終將導(dǎo)致慢性右心衰竭。以前外科修補(bǔ)術(shù)是ASD的主要治療手段,近年來(lái)隨著隨著介入技術(shù)日益成熟,越來(lái)越多的ASD患者可以通過(guò)介入手術(shù)進(jìn)行治療,減少了手術(shù)創(chuàng)傷,減輕了患者的痛苦,縮短了住院時(shí)間,介入封堵治療房間隔缺損以其突出的優(yōu)勢(shì)逐漸成為微創(chuàng)治療ASD的首選方法。然而并不是所有ASD都可以運(yùn)用介入封堵治療,缺損要有符合封堵的條件,這就要求術(shù)前必須明確缺損的大小、位置、數(shù)量、殘邊等基本情況,如今隨著超聲技術(shù)的不斷發(fā)展,經(jīng)食道實(shí)時(shí)三維超聲心動(dòng)圖的出現(xiàn)是超聲技術(shù)領(lǐng)域的又一歷史性突破,它實(shí)際上是胃鏡技術(shù)與超聲檢查結(jié)合的產(chǎn)物,采用胃鏡檢查方法將超聲探頭插入受檢者試管內(nèi),由于不受胸廓、肺部疾病的影響,離心臟較近,故可清晰地顯示心內(nèi)組織結(jié)構(gòu),及其相對(duì)空間位置,本研究主要探討經(jīng)食道實(shí)時(shí)三維超聲心動(dòng)圖在房間隔缺損介入封堵術(shù)中的臨床應(yīng)用價(jià)值。目的評(píng)價(jià)經(jīng)食道實(shí)時(shí)三維超聲心動(dòng)圖在II孔型房間隔缺損(ASD)封堵器型號(hào)選擇中的臨床應(yīng)用價(jià)值。方法62例先心病單純II孔型房間隔缺損(ASD)患者,術(shù)前均行二維經(jīng)胸超聲(2D-T TE)、二維經(jīng)食道超聲(2D-TEE)檢查測(cè)量ASD最大徑及實(shí)時(shí)三維經(jīng)食道超聲(RT-3D-TEE)檢查測(cè)量ASD最大直徑及面積。將所得測(cè)結(jié)果與房間隔缺損封堵器(ASO)型號(hào)作對(duì)比。結(jié)果60例患者成功接受經(jīng)導(dǎo)管房間隔缺損封堵術(shù)(TCASD)治療,術(shù)后均未探及殘余分流,1例因經(jīng)食道實(shí)時(shí)三維超聲診斷為多孔型房缺而放棄封堵,1例因上腔靜脈側(cè)殘邊缺如放棄封堵。RT-3D-TEE、2D-TEE和2D-TTE的ASD最大徑與ASO型號(hào)相關(guān)良好(r=0.881、0.798、0.702),RT-3D-TEE測(cè)量面積與ASO型號(hào)相關(guān)性系數(shù)為0.912,最大徑的相關(guān)性RT-3D-TEE測(cè)量的最高,同時(shí)運(yùn)用RT-3D-TEE測(cè)量面積和封堵器型號(hào)的相關(guān)性比此三種方法測(cè)量ASD最大徑的相關(guān)性高。結(jié)論實(shí)時(shí)經(jīng)食道三維超聲心動(dòng)圖像可為房間隔缺損提供更準(zhǔn)確的診斷信息,能較精確地測(cè)量出房間隔缺損的面積和最大徑,在房缺封堵中能為封堵器型號(hào)的選擇提供可靠的參考。
[Abstract]:Background Atrial septal defect (ASD) is one of the most common congenital heart diseases, which is usually the second most common congenital heart disease, due to the abnormal development of atrial septum, which leads to incomplete development and the defect between left atrium and right atrium. As a result of long-term left-to-right shunt at the atrial level, some left atrial blood enters the right atrium through ASD and repeatedly passes through the pulmonary circulation, resulting in an increase in the volume load of the left atrium, the right atrium and the right ventricle, mainly resulting in the expansion of the right atrium and the right ventricle, and the thickening of the ventricular wall. As a result, the right ventricular capacity is overloaded. With the increasing of the right ventricular capacity load, chronic right ventricular failure will eventually be caused. In recent years, with the increasing maturity of interventional technology, more and more ASD patients can be treated by interventional surgery, reducing the surgical trauma and alleviating the pain of ASD. Interventional closure of atrial septal defect (ASD) has become the first choice for minimally invasive treatment of ASD due to its outstanding advantages. However, not all ASD can be treated by interventional closure, and the defect should meet the requirements of closure. This requires that the size, location, quantity and residual edge of the defect should be clearly defined before the operation. Nowadays, with the continuous development of ultrasound technology, it is necessary to determine the size, location, quantity and residual edge of the defect. The appearance of transesophageal real-time three-dimensional echocardiography is another historic breakthrough in the field of ultrasound technology. In fact, it is the product of the combination of gastroscopy and ultrasound examination. The ultrasound probe is inserted into the test tube of the subjects by the method of gastroscopy. Because it is not affected by chest and lung diseases and is closer to the heart, it can clearly show the structure of the heart tissue and its relative spatial position. The purpose of this study was to evaluate the clinical value of transesophageal real-time three-dimensional echocardiography in transesophageal transcatheter closure of atrial septal defect (ASD). Objective to evaluate the clinical value of transesophageal real-time three-dimensional echocardiography in selecting the type of (ASD) occluder for II hole atrial septal defect (ASD). Methods 62 patients with congenital heart disease (CHD) with simple II hole atrial septal defect (ASD) underwent two-dimensional transthoracic ultrasound (2D-T TE),) before operation. Two-dimensional transesophageal ultrasound (2D-TEE) was used to measure the maximum diameter of ASD and three-dimensional real-time transesophageal ultrasound (RT-3D-TEE) was used to measure the maximum diameter and area of ASD. The results were compared with the type of atrial septal defect occluder (ASO). Results 60 patients were successfully treated with transcatheter closure of atrial septal defect (TCASD). No residual shunt was detected after operation. One patient gave up closure due to transesophageal real-time three-dimensional ultrasound diagnosis of perforated atrial septal defect. RT-3D test showed that the maximum diameter of ASD of 2D tee and 2D-TTE was correlated well with ASO type (r = 0.881, 0.798, 0.702). The correlation coefficient between RT-3D-TEE measured area and ASO type was 0.912, and the correlation coefficient was 0.912 between the measured area of RT-3D-TEE and the ASO type (r = 0.881, 0.798, 0.702). The correlation of the maximum diameter measured by RT-3D-TEE is the highest, and the correlation between the area measured by RT-3D-TEE and the type of occluder is higher than the correlation of the three methods for measuring the maximum diameter of ASD. Conclusion Real-time transesophageal three-dimensional echocardiography can provide more accurate information for the diagnosis of atrial septal defect and can accurately measure the area and maximum diameter of atrial septal defect. It can provide reliable reference for the selection of occluder model in the closure of atrial defect.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.1

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