1424史国匿蕴：!!!生!!旦箜!鲞笙!!塑￡!i塑丛型丛堕：Q!!!!型!!!!：!!!：!：盟!：!!继发孔型房间隔缺损介人封堵术后残余分流解析牛宝荣杨娅李晓明吴山马宁李宜嘉张涵张琪张纯【摘要1目的分析先天性心脏病继发孔型房间隔缺损介入封堵术后发生残余分流的原因、防治措施及估测预后。方法使用经胸、经食管超声心动图的二维及三维成像，对2010年8月至2013年8月首都医科大学附属北京安贞医院56例房间隔缺损介入封堵术治疗后发生残余分流的患者进行回顾性分析。结果56例患者中男性18例，女性38例，其中单发性房间隔缺损46例(82．1％)，多发性房间隔缺损10例(17．9％)；术后微量残余分流的患者32例(57．1％)，少量残余分流的患者22例(39．3％)，中量残余分流的患者2例(3．6％)，检出的残余分流以微量残余分流为主；患者残余分流在术后即刻被检出的有45例(80．3％)，术后3d复查时检出的有9例(16．1％)，3个月复查时检出的有l例(1．8％)，6个月复查时检出的有1例(1．8％)。结论房间隔缺损介入封堵术后残余分流出现的原因大多是术前未能准确评估房间隔缺损的数目、大小、形态、解剖毗邻及边缘的软硬程度。i维超声心动图能够提供三维立体图像，能更准确地反映房间隔缺损的形态结构，可为临床提供更为迅速有效的信息。【关键词】房间隔缺损；介入封堵术；残余分流【中图分类号】R541．1【文献标识码】ARetrospectiveanalysisofresidualshuntsaftertranscatheterclosureofforty-fivepatientswjthatrialseptaldefectsNtuBaorong，YangYa，LiXiaoming．WuShah，MaNtng，LiYijia．ZhangHan，ZhangQi1ZhangChun．EchocardiographyNolLab．BeijingAnzhenHospital，CapitalMedicalUniversity，Beijing100029，ChinaCorrespondingauthor：ZhangChun，Emai!：chh6778@163．corn【Abstract】ObjectiveToretrospectivelyanalyzethereasonsandpreventivemeasuresforresidualshuntsaftersuecessfultranscatheterclosureofatrialseptaldefects．MethodsBetweenAugust2010andAugust2013．fifty．sixpatientswithatrialseptaldefeetswhounderwenttranscatheteratrialseptaldefectsclosureweredetectedforresidualshuntandretrospectivelyanalyzed．ResultsAtotalofthe56atrialseptaldefects．including18maleand38female．46(82．1％)hadsingleatrialseptaldefectsand10(17．9％)hadmultipleatrialseptaldefects．Inpa—tientswithresidualshunts．thepatientswithtraceresidualshuntswere32(57．1％)：smallamountsofresidualshuntswere22(39．3％)：moderateamountsresidualshuntwere2(3．6％)andtracereSidualshuntswereinthemaiority．Theresidualshuntthatwasdetectedafterthetranseatheterclosurewere45(80．3％)：theresidualshuntthatwasdetectedafter3dayswere9(16．1％)：theresiduaIshuntthatwasdetectedafter3一monthwas1(1．8％)：theresidualshuntthatwasdetectedafter6一monthwasI(1．8％)．ConclusionsThecausesofresidualshuntaf-terthetranscatheterclosureofatrialseptaldefeetsdonotaccuratelyestimatethedefectsize，morphology，sur—roundingstructuresanddegreeofsoftandhardedge．Three．dimensionalechocardiographvcanmoreaccuratelyidentifyatrialseptaldefectsshapeandprovidemoreaccurateindextoguidetranscatheterdeviceimplantationthantwodimensionalechocardiography，【Keywords】Atrialseptaldefects；Transcatheterclosure；Residualshunt房间隔缺损是成年人常见的先天性心脏畸形疾病之一，根据解剖学和缺损位置不同，房间隔缺损可以分为多种类型，最常见的是在卵圆窝处的二孔房间隔缺损，多见于女性患者¨1。房间隔缺损以形态多变著称，病理学的研究显示房间隔缺损有不同的形状和大小，从形状来看可以分为椭圆形、圆形、复一部DOI：10．3760／cma．j．issn1673-4777．2014．10．006基金项目：首都医科大学基础-』临床科研合作基金(13JL05)作者单位：100029首都医科大学附属北京安贞医院超声心动图通信作者：张纯，Email：ehh6778@163．COill．论著杂形。随着介入治疗技术...
