ĐÓNG THÔNG LIÊN NHĨ QUA ỐNG THÔNG dưới HƯỚNG dẫn của SIÊU âm TRONG BUỒNG TIM (ICE)

I NG DN CA SIÊU ÂM
TRONG BUNG TIM (ICE)

Nguyễn Thượng Nghĩa, Võ Thành Nhân



Mục tiêu: 

Cơ sở nghiên cứu: 


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
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Phương pháp nghiên cứu và kết quả
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 
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 

Kết luận:  



Từ khóa: 

SUMMARY
INTRACARDIAC ECHOCARDIOGRAPHY (ICE) IN GUIDING TREATMENT
INTERVENTION OF ATRIAL SEPTAL DEFECT VIA CATHETER
Background: Intervention treatment of atrial septal defect (ASD) through the catheter is
becoming more popular worldwide and in Vietnam in the recent period. Most cases of atrial
septal defect are closed though catheter under guiding of the esophageal echocardiography and
cardiac catheterization.
Intracardiac echocardiography (ICE) is diagnostic imaging techniques of modern
cardiovascular medicine that have been applied recently and helped guide some cardiovascular
procedures more efficiently with more safety. Therefore, the assessment of the efficacy and
safety of ICE in guiding closure of ASD becomes necessary, especially when compared to some
other routine methods such as transthoracic echocardiography (TTE), transesophageal
echocardiography (TEE), Cardiac Catheterization.
Objectives: This study was done to determine the feasibility and safety of intracardiac
echocardiography (ICE) in guiding treatment intervention of atrial septal defect through the catheter.
Methods and results: This is an open, prospective study. 40 patients was done closure of
ASD though the ICE guidance during the period from December 2009 - 8 / 2010 at the
Interventional Cardiology Department Cho Ray Hospital. ICE was successfully performed in all

40 patients (100%). Closure of ASD with Amplatzer devices under ICE guidance are made
successful in 36 /37 cases (97.3%). ICE correctly detected 4/40 cases (10%) multiple- hole ASD
that were missed by transthoracic echocardiography (TTE) or transesophageal echocardiography
(TEE); help accurately identify atrial septal defect anatomy, the number of ASD holes and the
proper technique to close ASD (1 case using ASO Cribiform device closure of many fenestrated
holes, 3 cases of two- hole ASD using a larger ASO device to close both holes). ICE help
identify 3 cases can not be measured the size of ASD when the sizing balloon 34 is pumped up
maximal but the residual flow is still persist. ICE identified the exact position of ASO devices
and the residual flow post procedures in 36/37 patients (97.3%). ICE can detect serious events
that occur during the procedures such as: the position of ASO device is not good or affect the
surrounding structures, or drop out in the heart chambers, pericardial effusion (1 case).
Complications occurred following the procedures: pericardial effusion: 1 case, coughing up
blood: 1 case, temporary elevation of ST segment: two cases.
Conclusion: Closure of secondary ASD with ASO device under guiding of the ICE is a
mean of diagnosis and treatment of congenital heart disease safe and effectively when compared
with conventional methods: TTE, TEE and cardiac catheterization. Preliminary results of this
study showed that ICE could help the closure of ASD with ASO device without TEE or
anesthesia during the procedure.
Keywords: atrial septal defect, intracardiac echocardiography (ICE)

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công khá cao.
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      
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

ASO, Helex, STAR
[1],[2].

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




 


 

 

[3],[4],[5].


(ASD).










: 
; 

:

tim p 






bít dù.









ng tim.


45 Cranial 25.





th


 


-àu.


Dùng Aspirin 81mg trong 6 tháng sau bít dù.

STATA 10.0 . Các bi


III. 
3.1. T
TT
Phái

AIAS


ASD
TTE
TEE
ICE
Angio
ASO
1

52
Không
1
10
14
12
12
14
2

49
Không
1
9
11
11
11
12
3

26
Không

1
10
20
20
20
22
4

51
Không
1
12
17
18
20
22
5

26
Không
1
17
18
20
22
26
6

49
Không

1
9
13



Không

7

39
Không
1
19
23
24
24
28
8

66
Không
1
13
16
16
17
18
9


37
Không
3
12
4,6,7
5,6,7

35
10
Nam
53
Không
1
22
29
28
28
30
11

49
Không
2
14
18
7,21
22
24
12


32
Không
1
16
18
22
24
24
13
Nam
46
Không
1
13
18
18
18
18
14

37
Không
1
22
22
20
22
26
15


25
Không
2
22
22
6,21
22
26
16

42
Không
1
16
20
21
22
26
17

42
Không
1
12
12
21
22
24
18


25
Không
1
16
18
29
29
30
19
Nam
51
Không
1
22
24
23
25
26
20

51
Không
1
18
20
19
20
22
21


26
Không
1
23
25
33
36

22

23
Không
1
16
18
25
26
30
23

32
Không
1
24
25
26
28
30
24


21
Không
1
22
26
26
29
30
25

32
Không
1
16
16
18
19
20
26
Nam
23
Có
1
14
16
19
21
22
27


54
Không
1
13
14
16
16
18
28

24
Không
1
11
17
22
22
24
TT
Phái

AIAS

ASD
TTE
TEE
ICE
Angio
ASO
29


14
Không
2
12
14
7,17
7,20
24
30

28
Không
1
11
11
14
13
15
31

31
Không
1
29
29
32
32
32
32


36
Không
1
14
15
19
18
20
33

39
Không
1
10
12
12
13
15
34

51
Không
1
17
18
22
24
26
35


22
Không
1
14
16
19
21
22
36

27
Không
1
18
19
24
24
26
37
Nam
32
Không
1
25
25
32
34
Không


38

18
Không
1
14
15
20
22
24
39

27
Không
1
13
15
27
30
32
40

56
Không
1
10
12








Phái nam




36,9  12,8 (14  66)
Kí
15,5  5,3 ( 4 - 29)

17,7  5,2 ( 7  29)

21,6  5,7 (12 -34)
 
22,6  6,0 ( 12 -35)

23,7  5,2 (12 -32)


           


- 

-                
(angiogr
 (Two-sample t test with equal variances)

- 
 (Two-sample t- test with equal variances)
- 

0.48. (Two-sample t- test with equal variances)

  




g


Phình vách liên


40




39
1



35
3
1

1
  



       


Thành công

Thành công



40/40 (100%)
40/40 (100%)
0 /40

40/40 (100%)
40/40 (100%)
0 /40

40/40 (100%)
40/40 (100%)
0 /40

37/38 (97%)
37/38 (97%)
1/38
5. Siêu âm quá trình bít dù thông liê

36/37(97%)
36/37 (97%)
1/37

36/37 (97%)
36/37 (97%)
1/37

36/37 (97%)
36/37 (97%)
1 /37

(1:Ho ra máu; 1: TDMNT)
2/40 (5%)
2/40
2/40 (5%)
1. 


2.           




3. 



               
 


 




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
 
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


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M[1],[3]
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Trong 
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                


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            
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



:















tim.


- Siêu âm tr
 
 

- 



- 
 



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