Function of echocardiography in transcatheter closure of ruptured sinus of valsalva aneurysm
Yue LI, Guang-yi Wang , Zhi-feng Wang，Hai-jun Hou
Department of Ultrasound，People's Liberation Army General Hospital, Beijing 100853, China
Methods 40 RSVA closured by transcatheter intervention in which 3 cases come from our hospital, other 37 cases come from the date reported in domestic and international from 1995 to 2007. Age 7~74 years old. Male19, female 21. Sum up the location and size of RSVA, closure methods, effection of closure in all of patients. Especially focused on the function of echocardiography before, during and after RSVA closure procedure .
Results Among 40 patients there were 6 RSVA complicated other congenital malformation. 4 RSVA succeeded to cardiac surgery. 37/40 patients gained correct diagnosis by Two-dimensional and color Doppler echocardiography before interventional treatment. But other 3 patients, 1 suspect of cronory artery-vine fistula，1 suspect ventricular septal defect cmbined with aortic valve regurgitation, and another misdiagnosed RSVA, which was RSVA complicated ventricular septal defect. The echocardiography revealed the ruptures of right coronary sinus into right ventricle at 29 site , right coronary sinus into right atrium at 3 site, noncoronary sinus into right atrium at 9 site. noncoronary sinus into right ventuicle at 1 site. During closure procedure. needed echocardiography for guiding and monitoring, with transesophageal echocardiographic (TEE) in 7 cases and with transthoracic ehcocardiographic(TTE) In all of 40 patients 30 Amplatzer duct occluder, 4 ventricular septal occluder, 3 Rashkind umbrella, 2 Gianturco coil and 2 atrium septal occluder were successfully deployed. The estimated size of the aortic opening site of the RSVA was 2-12 mm. It should be note after catheter or sheath pass through the opening site remeasured diameter of the rupture orifice by echocardiography may be larger than earlier measured result. In most patients the size of the occluder was chosen to be at least 1 to 4 mm larger than the maximal diameter of the opening site as measured by echocardiography or angiocardiography. Immediately after occluding the rupture orifice echocrcardiographyu had advantage in assessment of closure effect, particularly in distinguishing residual shunt and aortic valve regurgitation. Follow up mainly depend on echocardiography. After intervention 1 case who had residual shunt developed hemolysis and was sent for surgical repair.1 case died of progressive congestive heart failure. Other 38 patients were asymptomatic and no complications.
Conclusions Echocardiagraphy is absolutely necessarily tool for Transcatheter closure RSVA. Before intervention it was preferred diagnosis modality. During intervention it is help for selecting the size of occluder more accurate. Immediately after intervention it is excel angiography for distinguish residual shunt and aortic valve regurgitaion. Because the limitation of date there are more experience and rule need to build up and formulate in application of echocardiography in RSVA intervention.
