- 期刊
The Clinical Application of Real-Time Three Dimensional Color Echocardiography to Monitor Balloon Atrial Septostomy in Cyanotic Neonates with Congenital Heart Disease and Transposition of the Great Ar
以三度空間實時間彩色超音波心圖監測發紺先天性心臟病合併大血管轉位症嬰幼兒執行心房中隔氣球造口術之臨床應用分析
摘要
此篇研究之目的在於分析在新生兒加護中心，以三度實時間彩色超音波心圖監測發紺先天性心臟病合併大血管轉位症嬰幼兒執行心房中隔氣球造口術之臨床應用。自2004年9月至2007年9月共計有6位嬰幼兒符合上述之診斷，而需緊急進行心房中隔氣球造口術。所有的操作過程均於新生兒加護中心進行，當氣球導管置放入下腔靜脈到達橫隔膜之高度時即進行三面實時間彩色超音波心圖監測。此六位幼兒於氣球造口術後均獲得良好之結果，在監測的過程中，特別著重於氣球導管的定位，氣球導管瞬間向後的拉力，以及附近心臟內結構三度空間的相關性。研究結果顯示此三度空閒實時間彩色超音波心圖監測確實可以瞬間反應導管與心房及心臟內結構三度空間相關性，避免如同二維超音波心圖仍需在腦海內重新作空間的組合，因此我們認爲此新監測技術的應用普遍將更可減少心房中隔氣球造口術之危險性，且在新生兒加護中心即可完成，不須移送到心導管室進行。
並列摘要
The purpose of this study was to evaluate the clinical application of realtime three-dimensional color echocardiography (RT-3DE) to guide transcatheter atrial septostomy in the intensive care unit (ICU) in neonates with congenital heart disease and transposition of the great arteries. Between Sept. 2004 and Sept. 2007, a total of 6 neonates were diagnosed with transposition of the great arteries and critical cyanosis requiring transcatheter atrial septostomy. The procedure was performed at the bedside in the ICU using conventional transeptal catheters in all six cases guided by RT-3DE once the catheter was advanced to the diaphragm level. The transcatheter atrial repository was successfully performed with guidance by RT-3DE in all of the 6 neonates. There were no complications except in 1 patient who developed sepsis 3 days after the procedure. The critical steps during transcatheter atrial septostomy include advancing the balloon catheter into the left atrium, positioning and full expansion of the balloon, sudden withdrawal of the catheter from the left to the right atrium with the balloon inflated, abrupt cessation of withdrawal of the balloon catheter to avoid damaging the vena cava, and balloon deflation. All of these steps were monitored and guided by RT-3DE at the bedside. This new approach allows immediate visualization of the balloon catheter in the atrial chamber without further image reconstruction that is required with conventional two-dimensional echocardiography. It may further decrease the risk of this procedure.
延伸閱讀
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