经导管闭合前心房通路的超声心动图评估
Summary
经胸 （TTE） 和经食管 （TEE） 超声心动图是房间隔间隔检查的基本成像工具。三维 （3D） TEE 为评估心房间隔提供增量信息。使用斑点跟踪超声心动图的进一步高级超声心动图技术应用于心腔的敏感容量和功能评估。
Abstract
经胸 （TTE） 和经食管超声心动图 （TEE） 是房间隔缺损 （ASD） 和卵圆孔未闭 （PFO） 检测、患者选择经导管 ASD/PFO 闭合、术中指导和长期随访的标准影像学方法。确定心房通讯的大小，形状，位置和数量。通过使用搅拌盐水以及瞬时增加右心房（RA）压力的操作，可以提高PFO检测的准确性。RA 混浊后 3 个心脏周期内左心房 （LA） 出现微气泡被认为对存在心内分流呈阳性。三维 TEE 可进一步识别室间隔开窗，并描述 ASD/PFO 和房间间隔动脉瘤的动态形态。建议在手术后 1 个月、6 个月和 12 个月进行 TTE 随访评估，随后每年进行一次评估。先前的研究表明，装置闭合后早期房性心律失常的发生率增加。斑点追踪分析可能有助于了解经皮闭合后的功能性左心房重塑及其对房性心律失常的影响。
Introduction
卵圆孔（PFO）不是房间隔的真正组织缺陷;它存在于约20-25%的成年人口中，在大多数情况下它没有任何临床意义（图1）。隐源性卒中约占缺血性卒中的 30%，被定义为在患者早期病情检查时没有明显病因的疾病。45岁以下的患者占卒中负担的10%，高达40%被定义为隐源性。使用经导管闭合技术对卒中进行二级预防对于降低发病率和死亡率仍然至关重要1。
房间隔缺损 （ASD） 包括不同房间隔位置的不同病变，导致分流。最常见的形式是肺动脉中段 ASD，通常最适合经脉功能闭合。ASD通常见于右心室（RV）功能障碍和/或扩张的病情检查期间，很少见于疑似矛盾性栓塞或隐源性卒中后2，3。
进行经胸 （TTE） 和经食管 （TEE） 超声心动图，以定性和定量评估房间隔缺损。三维（3D）TEE提供更深入的心房间隔信息，并在术中引导期间提供更精确的导管和闭合装置成像。术后 TTE 随访评估应在术后 1 个月、6 个月和 12 个月进行，随后每年进行评估，以评估器械位置、残余分流、心包积液、心房大小和功能的变化以及肺循环。使用斑点跟踪超声心动图的进一步高级超声心动图技术可能有助于了解经皮闭合后潜在的功能性左心房重塑及其对房性心律失常的影响2。
Protocol
在下一部分中，我们将根据国际临床指南，描述经导管闭合前心房通路临床和影像学评估的方案步骤。这些协议遵循塞梅尔威斯大学科学与研究伦理区域和机构委员会的指导方针。需要知情的书面患者同意。 1. 隐子卒中和PFO的经导管闭合的临床评估和工作流程 对于卒中的诊断性检查，使用计算机断层扫描 （CT） 或磁共振脑成像 （MRI） 确定卒中是缺血性?…
Representative Results
41岁女性患者有症状的临床评估显示腹腔型ASD和心房间隔松弛，采用TTE和TEE检查TTE 检查显示右心室和双心室肿大伴肺动脉收缩压升高。TEE检查用于使用2D和3D方法估计ASD的大小和形状。比较了2D，3D原生和气球尺寸TEE测量值（图4， 图5， 图6）。在松软性房间隔的情况下，术中球囊尺寸非常重要，因为即使进行3D测量，在这种?…
Discussion
仔细选择经导管 PFO 闭合的患者是临床评估中最具有挑战性的步骤之一，因为排除心房颤动可能很困难。过去几年的几项试验表明，通过长期监测来检测心房颤动，可以提高产量。18 隐源性卒中和潜在心房颤动 （CRYSTAL-AF） 试验发现，与标准监测技术 （1.4%） 相比，可插入式心脏监护仪组的心房颤动发生率 （8.9%） 增加了 6 个月，在隐源性卒中患者中，这一比率攀升至 12.4% 和 2.0…
Divulgations
The authors have nothing to disclose.
Acknowledgements
项目编号NVKP 16-1-2016-0017（”国家心脏计划”）已在匈牙利国家研究，发展和创新基金的支持下实施，该基金由NVKP 16资助计划资助。该研究由匈牙利创新和技术部的主题卓越计划（2020-4.1.1.-TKP2020）资助，在塞梅尔威斯大学的治疗开发和生物成像主题计划的框架内。
Materials
| TomTec Imaging workstation | TomTec Imaging, Unterschleissheim, Germany | 4D LALV Function analysing software | |
| Ultrasound machine | Philips Epiq CvX | serial number US81881251 | X5-1 and X7 transducers |
| Wiwe external ECG single chanel recorder | Sanat Metal | 5-810-200-1611 | external ECG single chanel recorder |
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Tags
Echocardiographic EvaluationAtrial CommunicationsTranscatheter ClosureTransthoracic EchocardiographyTransesophagael EchocardiographyInteratrial Septum DeficienciesThree-dimensional EchocardiographyLeft Atrial Mechanical Function2D Transthoracic Echocardiographic ImagingParasternal Short Axis ViewLeft Atrial StrainTricuspid Annular Plane Systolic ExcursionRight Ventricular Fractional Area Change3D Analysis3D Left Ventricle And Right Ventricle Volume And Function Measurements
Citer Cet Article
Molnár, A. Á., Ábrahám, P., Merkely, B., Nardai, S. Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure. J. Vis. Exp. (180), e61240, doi:10.3791/61240 (2022).