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Transthoracic echocardiography aneurysm of membranous ventricular septal defect classification and role in the interventional treatment of Ventricular septal defect echocardiography (Zhen Hospital, Capital Medical University, Beijing) Minimally invasive breast pump atrial septal, ventricular septal defect occlusion of the clinical application
Documents were cited China Academic Journal ago 10 1 Heng, including Zong, Cai Xin, Gao victory, Shi Xiaojun, Wang Ju, Song Wei, Lv Hongan; septal occluder treatment efficacy of perimembranous ventricular septal defect initial evaluation [J]; Anhui Medical; 2004 06 2 Chen Xiaobin; Po Xiao groups; Zheng Zhaofen; Yang Lun; Lichuan Chang; Deng Jinhua; Meng cream Yuan; Xie Xiumei;; complex congenital heart disease earlier intervention of the safety and efficacy [J]; Journal of Clinical Research; 2007 3 Korean War in 02 camps; Tao Hailong; Yang Haibo; Jenn-Wen Huang; Qinshi Cheng; Qiu Chunguang;; ventricular septal defect transcatheter closure of surgical approach [J]; Medical Forum; 2006 10 4 dense forest; Jia Bin; Solution Kai Lin; Wang Zhen; ZHU Xiao; amount Dalton Gaowa; Gao Lei; Tan Huilian; Liu Ling;; 586 cases of complications of interventional treatment of congenital heart disease [J]; clinical meta; 2006 19 5 Li Jingbang; Lee atlas; Zhang Yushun; generation of political science; Wang Lei; Zhang Jun; Jun; Wang Xiaoyan;; membranous ventricular septal defect complications of interventional treatment [J]; Practical Radiology; 2006


06 6 Zhang Yushun, Jia Shao Bin, Wang Zhen , on behalf of political science, Huan Li, Li Jun, Zhang; interventional treatment of residual shunt after repair of ventricular septal defect [J]; Heart Journal; 2005 02 7 Zhang Yushun, on behalf of political science, Huan Li, Li Jun, Zhang Jun, Wang Xiaoyan; ventricular septal defect complicated by tricuspid valve regurgitation after intervention because of [J]; Heart Journal; 2005 02 8 Zhang Yushun, Li Huan, on behalf of political science, Li Jun, Zhang Jun, Wang Xiaoyan; ventricular septal defect occluder interventional therapy was complicated because of the shift [J]; Heart Journal; 2005 02 9 Lei Yun, Zhang Weihua, Yin Xiaolong, Ding Yunchuan, Yaoyu Fan; interventional treatment of heart malformation complex study of the efficacy and safety [J] ; Heart Journal; 2005 02 10 Zhang Yushun, on behalf of political science, Li Huan, Wang Lei, Zhang Jun, Li Jun; aortic edge of less than 2 mm perimembranous ventricular septal defect evaluation of interventional treatment [J]; Heart Journal; 2005 PhD thesis on 02 full-text database of China prior to a 1 Zhu Ting; real-time three-dimensional ultrasound imaging and pathological structure of the relevant anatomy and application of [D]; Fourth Military Medical University; master's degree in China in 2004 before a full paper database Article 1 Oscilloscope; serum cardiac troponin therapy in congenital heart defects before and after the change and its related factors [D]; Hebei Medical University; 2007
Abstract Objective: To evaluate transthoracic echocardiography (TTE) in ventricular septal defect occlusion in the role. Methods: Using color Doppler transthoracic echocardiography under the guidance of 48 patients with ventricular septal defect (VSD) closure in patients with treatment, and intraoperative and postoperative data were analyzed in detail. Results: 48 patients were successfully treated closure success rate was 100%. Successful surgery, surgery patients without discomfort. 48 patients were measured preoperatively by TTE VSD defect size 3 mm ~ 14.5 mm, slightly larger measuring intraoperative angiography, but no significant difference. Intraoperative monitoring of 48 patients and the delivery of occluder release. Room after the release of the 47 patients the level of shunt disappeared, there is a small shunt in 1 case. After 3 d ~ 1 a reof TTE, 1 patients presented with a small shunt in patients with shunt disappeared, 48 cases were fixed in occluder position, around the valve movement were not affected, no new valvular regurgitation, and no hemolysis, heart endometritis, blood clots and other complications. Conclusion: TTE VSD occluder on the preoperative patient selection, guidance and monitoring of intraoperative and postoperative follow-up treatment have a very important role.
Key words Color Doppler transthoracic echocardiography (TTE) ventricular septal defect (VSD) occluder
Children with congenital heart disease is the most common heart disease was detected in 0.7% of newborns, and one ventricular septal defect (VSD) of the high incidence of congenital heart disease accounts for about 25% to 30% [ 1]. The past, the only treatment is surgical VSD thoracic surgery, since 1988, Lock et al [2] double umbrella closure VSD was first reported since, there have been a variety of sealing devices used clinically, especially in the United States in 2002 AGA Company developed a new Amplatzer membranous VSD occluder application that allows ultrasound-guided interventional treatment of VSD technology maturity. Application of the past two years our hospital has treated 48 cases of the technology VSD patients, were successful. This paper analyzes the TTE of the VSD occluder before the patient screening, intraoperative monitoring guidance, and after reof the application, are reported below.2 a to our hospital 48 patients were treated VSD patients, 27 males and 21 females, aged 5 years to 39 years, mean age 15.5 years, preoperative diagnosis by TTE. 35 cases of perimembranous VSD, defect size is about 3 mm ~ 14.5 mm, average 6.03 mm; 12 aneurysm rupture of membranes, and the break are more than 2, the smallest inner diameter of about 1 mm or so break; 1 case VSD combined PDA (patent ductus arteriosus), VSD defect was 6.5 mm, PDA diameter was 8.5 mm.
1.2 Instrument
PHILIPS 5500 use of color Doppler ultrasonic diagnostic apparatus, the frequency 2.5 MHz ~ 4 MHz Cardiac Probe, occluder provided by the Shanghai shape memory.
1.3 Methods
Preoperative TTE major left ventricular long axis , short axis of the great vessels, apical four-chamber section, apical five-chamber and parasternal five-chamber , and more than the maximum diameter of VSD observed section, shape, location, number, and the edge away from the aortic valve defect, tricuspid septal leaflet in the distance. X-ray and intraoperative monitoring of TTE, the femoral artery, left ventricle, ventricular septal defect, right ventricle, right atrium, inferior vena cava, femoral vein to establish the track into the closure device, in the five-chamber of TTE monitoring under the guidance of the left ventricular side of the disc occluder and left ventricular septal surface by the close phase, and retracement of the sheath, the right ventricular disc opening; confirmed by TTE occluder position monitor appropriate occluder waist expand, and so the left and right ventricular septal disk, respectively, no significant residual shunt, on the septal leaflet, aortic valve and right ventricular outflow tract had no effect, and then further confirmed by imaging and auscultation noise disappears, release the occluder. After 3 d, 1 month, 3 months, 0.5 a and 1 a reof TTE, evaluation of treatment.48 patients (including 1 case of VSD + PDA patients are also blocked a PDA) were occluded successfully. 1 case from the aortic valve defect too close to the edge, place the eccentric occluder after a small amount of aortic valve regurgitation caused by the release of the former monitoring by TTE, adjust the occluder position, reflux then disappear. 1 case of membranous ventricular septal aneurysm patients, in the establishment of track, 6F delivery sheath, the repeated push, not through defect of mouth, consider whether the track into the small defect mouth, keep track, multi-slice repeatedly observed by TTE, found that patients with small and large shunt shunt disappeared there are still confirmed tracks into the mouth of a small defect. Reconstruction of track, into the delivery sheath, TTE surveillance confirmed the defect by a large mouth, sealing success. 1 case still existed after occluder release a small amount of shunt. 48 patients were reed after 3 d TTE, occluders are fixed in position, no shift, and around the valve movement were not affected, no new aortic valve, tricuspid regurgitation, no hemolysis, endocardial inflammation, thrombosis and other complications occurred. 3 months after ~ 1 a reof all patients showed no diversion.With the new Amplatzer occluder eccentric like the advent of transcatheter closure of VSD as in addition to traditional surgical repair of congenital heart disease outside another effective means of treatment, the trauma, rapid recovery, curative effect, etc. soon widely used in clinical [3]. The septal occluder and the advent of multi-product research and development, the involvement of our country to go in the treatment of congenital heart disease in the world. With other cardiac intervention is different, TTE prior cardiac interventional therapy plays an important role in [4]. Surgery for ventricular septal defect, the experience is as follows: As the VSD adjacent to the relations are very complex, surrounded by aortic, mitral and tricuspid valve and the atrioventricular bundle and other important structure, but the defect edges and often without sufficient not only operative difficulties, and the closure device and easy to produce pressure on surrounding tissue, influence valve motion, or arrhythmia [5], thus affecting the success rate of transcatheter closure. Thus, TTE rigorous screening patients before surgery successful VSD closure is very important. Should be used before surgery to determine VSD repeated observations of multiple facets of the position, shape, defect diameter mouth, a merger of the membrane aneurysm and surrounding tissue defect of the relationship between edge and to determine whether the implementation of interventional therapy, and clinical choice different types of closure devices of different sizes provide important information. We found that five-chamber of TTE, short axis of the great vessels and the actual measurement of VSD defect size of the defect size closest to slightly less than the imaging measurements, but no significant difference; five-chamber in judging the distance and the aortic valve, according to aneurysm morphology observed on the film and the actual is closer; four-chamber , short axis cut the face of the great vessels and the septal leaflet to determine the distance the more valuable. From the upper edge of the VSD defect is less than 1 mm aortic annulus cases should be carefully observe whether the aortic valve regurgitation; aneurysm rupture of membrane were also observed to be faceted surface membrane entry of left ventricular aneurysm size, How much the size of the export orientation, export the distance between the depth of tumor, degree and solid relationships with surrounding structures. This is the surgeon before surgery provides an important reference to facilitate ease of operation and estimated the likelihood of success. Plugging the gap can be a single gap in the export more and more distant to the base closure; the base of the membrane under a large aneurysm under ultrasound echoes to determine the strength of its solid level to choose whether to block exports. Intraoperative closure device delivery and release, TTE must be carried out under the guidance and monitoring to real-time observation of the spatial location of occluder, the impact on the surrounding tissue, whether there are diversion and other issues. Whether the release operation to provide for the occluder to provide important information. TTE follow-up study after closure of the periodic treatment, complications and so very easy and convenient.

In summary, intervention VSD is a safe, fast, effective treatment to reduce the patient's physical, mental and psychological burden, and do not scar the body surface, welcomed by patients and their families, it is worth further application. Preoperative TTE rigorous screening by patients, close monitoring of intraoperative guidance, postoperative follow-up is simple, significantly improved the success rate of interventional therapy, and have a good ultrasound equipment, ultrasound and preoperative multi-slice to carefully observe TTE TEE CHD can replace the interventional treatment of ventricular septal defect in the role. [1] Wei-Fong Wu, Zhang Guizhen. Practical echocardiography diagnostics [M]. Beijing: Chinese Medical Science and Technology Press ,1996:156-16
[2] Lock JE, Block PC, Mckay RC, et al. Transcatheter elosure of Ven tricular septal defects [J]. Circulation, 1988,78 (2) :361-36
[3], Xiang-Qing, Ke-Jiang Cao, Yang Rong, et al. Application of 32 patients with Amplatzer occluder closure of membranous VSD [J]. Chinese Journal of Interventional Cardiology ,-2
[4] Xia Hongmei, Gao Yun Hua, Yang, et al. Echocardiography in infants with congenital heart disease diagnosis [J]. Chongqing Medicine, 2003,32 (2): 20
[5] HoSY, Mccarthy KP, Rigby ML, et al. Morphology of perimem branous v entricular septal defect: implications for transcatheter device closure [J]. J Interven Cardiol, 2004,17 (2): 99.


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