柳昂,王珂,段福建,康文英,龚俊松,平措云旦,闫朝武

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院结构性心脏病中心
• 2:国家心血管病中心北京协和医学院中国医学科学院阜外医院麻醉中心
• 3:西藏自治区人民医院放射科

摘要(Abstract)：

目的 探讨体外膜肺氧合（ECMO）下床旁经食管超声心动图（TEE）引导房间隔造口术的可行性和安全性。方法 纳入2020年1月至2024年10月中国医学科学院阜外医院接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗下发生肺水肿患者8例（女2例、男6例）。所有患者在床旁TEE引导下穿刺房间隔，应用Inoue球囊行房间隔逐级球囊扩张（直径18～24 mm），扩张终点为左心房平均压力<15mmHg。术后评估房间隔瘘口大小、左心房平均压力及双肺水肿改变。结果 8例患者年龄（43.50±16.84）岁。所有患者均成功完成房间隔穿刺造口术，球囊扩张直径（22.75±2.68）mm，所造瘘口直径（6.31±0.37）mm，患者左心房平均压力由术前（26.63±1.77）mmHg降至术后（12.75±1.28）mmHg，差异有统计学意义（P<0.001）。术后所有患者双肺水肿及6例患者二尖瓣反流程度获得明显改善。无手术相关并发症发生。结论 床旁TEE引导下房间隔造口术安全可行，可有效降低ECMO治疗过程中左心高负荷，大幅改善双肺水肿。

关键词(KeyWords)： 经食管超声心动图;体外膜肺氧合;房间隔造口术;左心房减压

Abstract:

Keywords:

基金项目(Foundation): 中国医学科学院北京协和医学院临床与转化创新项目（2020-I2M-C&T-B-065）;中国医学科学院中央级公益性科研院所重大任务及行业支撑项目（2023-RW320-08）

作者(Author): 柳昂,王珂,段福建,康文英,龚俊松,平措云旦,闫朝武

参考文献(References)：

• [1] Lindstrom SJ, Pellegrino VA, Butt WW. Extracorporeal membrane oxygenation[J]. Med J Aust,2009,191(3):178-182. DOI:10.5694/j.1326-5377.2009.tb02735.x.
• [2] Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in adults:fundamental principles and systematic review of the evidence[J]. J Thorac Cardiovasc Surg,2016,152(1):20-32. DOI:10.1016/j.jtcvs.2016.02.067.
• [3] Smith M, Vukomanovic A, Brodie D,et al. Duration of venoarterial extracorporeal life support(VA-ECMO)and outcome:an analysis of the Extracorporeal Life Support Organization(ELSO)registry[J]. Crit Care, 2017,21(1):45.DOI:10.1186/s13054-017-1633-1.
• [4] Le Gall A, Follin A, Cholley B,et al. Veno-arterial-ECMO in the intensive care unit:from technical aspects to clinical practice[J]. Anaesth Crit Care Pain Med,2018,37(3):259-268.DOI:10.1016/j.accpm.2017.08.007.
• [5] Bhatia M, Katz JN. Contemporary comprehensive monitoring of veno-arterial extracorporeal membrane oxygenation patients[J].Can J Cardiol,2020,36(2):291-299. DOI:10.1016/j.cjca.2019.10.031.
• [6] Kloeckner M, Guihaire J, Hascoet S. Congestive pulmonary oedema during venoarterial extracorporeal membrane oxygenation support:a plea for balloon atrial septostomy[J]. Eur Heart J,2021,42(32):3103-3104. DOI:10.1093/eurheartj/ehab118.
• [7] Johnston TA, Jaggers J, McGovern JJ,et al. Bedside transseptal balloon dilation atrial septostomy for decompression of the left heart during extracorporeal membrane oxygenation[J].Catheter Cardiovasc Interv,1999,46(2):197-199. DOI:10.1002/（SICI）1522-726X(199902)46:2<197::AIDCCD17>3.0.CO;2-G.
• [8] Kon ZN, Pasrija C, Shah A,et al. Venovenous extracorporeal membrane oxygenation with atrial septostomy as a bridge to lung transplantation[J]. Ann Thorac Surg,2016,101(3):1166-1169. DOI:10.1016/j.athoracsur.2015.03.127.
• [9] Baruteau AE, Barnetche T, Morin L, et al. Percutaneous b a l l o o n a t r i a l s e p t o s t o m y o n t o p o f v e n o a r t e r i a l e x t r a c o r p o r e a l m e m b r a n e o x y g e n a t i o n r e s u l t s i n s a f e and effective left heart decompression[J]. Eur Heart J Acute Cardiovasc Care,2018,7(1):70-79. DOI:10.1177/2048872616675485.
• [10] Mlcek M, Meani P, Cotza M, et al. Atrial septostomy for left ventricular unloading during extracorporeal membrane oxygenation for cardiogenic shock[J]. JACC Cardiovasc Interv,2021,14(24):2698-2707. DOI:10.1016/j.jcin.2021.09.011.
• [11] Rashkind WJ,Miller WW. Creation of an atrial septal defect without thoracotomy. A palliative approach to complete transposition of the great arteries[J]. JAMA,1966,196(11):991-992.
• [12] K i p e l G, A r n o n R, R i t t e r S B. Tr a n s e s o p h a g e a l echocardiographic guidance of balloon atrial septostomy[J].J Am Soc Echocardiogr,1991,4(6):631-635. DOI:10.1016/s0894-7317(14)80225-3.
• [13] Ludomirsky A. The use of echocardiography in pediatric interventional cardiac catheterization procedures[J]. J Interv Cardiol,1995,8(5):569-578. DOI:10.1111/j.1540-8183.1995.tb00584.x.
• [14] Mahajan A, Shabanie A, Laks H. Interatrial septostomy under transesophageal echocardiography guidance:a novel approach[J]. J Thorac Cardiovasc Surg,2002,123(4):824-826.DOI:10.1067/mtc.2002.121760.
• [15] R a n d o l p h G R, H a g l e r D J, C o n n o l l y H M, e t a l. Intraoperative transesophageal echocardiography during surgery for congenital heart defects[J]. J Thorac Cardiovasc S u rg, 2 0 0 2, 1 2 4(6):11 7 6-11 8 2. D O I:1 0. 1 0 6 7/mtc.2002.125816.
• [16] Tsai SK. The role of transesophageal echocardiography in clinical use[J]. J Chin Med Assoc,2013,76(12):661-672.DOI:10.1016/j.jcma.2013.08.009.
• [17]余正春，马小静，刘燕，等.体外膜肺氧合治疗中超声心动图指导房间隔造口术的应用价值[J].中华超声影像学杂志，2021,30(5):388-391. DOI:10.3760/cma.j.cn131148-20201106-00862.
• [18] Lin YN,Chen YH,Wang HJ,et al. Atrial septostomy for left atrial decompression during extracorporeal membrane oxygenation by inoue balloon catheter[J]. Circ J,2017,81(10):1419-1423. DOI:10.1253/circj.CJ-16-1308.
• [19] Yan C. Is combined use of radiofrequency ablation and balloon dilation the future of interatrial communications?[J].Expert Rev Cardiovas,2022,20(11):895-903. DOI:10.1080/14779072.2022.2144233.
• [20] Piliero N,Bedague D,Fournel E,et al. The atrial flow regulator:a novel device for left ventricular unloading in patients receiving venoarterial extracorporeal membrane oxygenation support?[J]. Chest,2021,160(2):e165-e167. DOI:10.1016/j.chest.2021.03.048.