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经胸超声心动图监视下应用Amplatzer 封堵器治疗房间隔缺损(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2001年第5期
页码:
393-395
栏目:
先心病介入治疗
出版日期:
2001-09-01

文章信息/Info

Title:
Transcatheter closure of secundum atrial septal defects using Amplatzer occluder device with transthoracic echocardiography
作者:
张玉顺1;  代政学1;  刘建平1;  张　军2;  李　寰1;  贾国良1
第四军医大学西京医院: 1. 心血管内科, 2. 超声科, 陕西西安710032
Author(s):
ZHANG Yu-shun1;  DAI Zheng-xue1;  LIU Jian-ping1;  ZHANG Jun2;  LI Huan1;  JIA Guo-liang1
1. Cardiology Department of Xijing Hospital, Fourth Military Medical University, Xi’an Shaanxi 710032, China
关键词:
超声心动描记术;  房间隔缺损;  介入治疗
Keywords:
echocardiography;  transthoracic;  atrial septal defects;  transcatheter closure
分类号:
R541. 1; R540. 45　
DOI:
-
文献标识码:
A
摘要:
目的 评价在经胸超声心动图(TTE) 指导下置入Amplatzer 封堵器治疗继发孔型房间隔缺损(ASD) 的可行性和治疗效果。方法 全组50 例, 年龄1～ 51 (18. 8 土14. 6) 岁, 术前经TTE 检查示ASD 直径平均为4～ 33 (18. 3土6. 0)mm。所有病例均在透视及TTE 监视下经导管置入Amplatzer 封堵器封堵ASD。术后3 d, 1～ 3 月分别行经胸超声心动图、心电图及X 线检查评价治疗效果。结果 50 例ASD 直径的球囊测量值为5～ 35 (19. 1 土6. 9)mm , 选择的封堵器直径为5～ 36 (20. 9 土7. 0)mm。50 例封堵器置入均获得成功, 技术成功率为100% , 术中未发生任何重要并发症, 无急诊手术病例。术后即刻TTE 显示4 例(8. 0%) 存在微量至少量残余分流。术后3 天TTE 显示2 例( 4. 0%) 存在微量残余分流。术后1～ 3 月TTE 显示50 例ASD 完全闭合。X 线检查全部显示肺血减少、右心房、室缩小。结论 经胸超声心动图指导下经导管置入Amplatzer 封堵器治疗ASD 是一种有效、安全、可行的非外科手术方法。我们建议30mm 以上的ASD 应在经食道超声心动图下监视封堵。
Abstract:
AIM To evaluate the treatment efficiency and the feasibility of transcather closure of secundum atrial septal defect (ASD ) using Amplatzer occluder device by transthoracic echocardiography (TTE). METHODS There were 50 patients. The mean age was 18. 8±14. 6 years ( ranged from 1 to 51 years).The mean diameter of ASD was 18. 3±6. 0mm ( ranged from 4 to 33) shown by TTE before in terventions. Each case was occluded using Amplatzer occluder device through the percutaneous procedure. The closure proccdure was guided by fluoroscopy and TTE. TTE was performed immediately and TTE, ECG and X-ray examination were done 3 days and 1～ 3 months after the procedure to evaluate the efficiency. RESULTS The mean ballon stretched diameter of the ASDs was 19. 1 ±6. 9 mm ( ranged from 5～ 35 mm ). The mean diameter of the occluder selected was 20. 9± 7. 0 mm ( ranged from 5～ 36 mm ). The success rate of placement of Amplatzer occluder was 100%. No complications occurred during the procedure, and no one needed for emergency surgery. Trivial to small residual shunts were found in 4 cases (8. 0% ) immediately after the procedure, in 2 cases ( 4. 0% ) 3 days. No residual shunts was found in 1～ 3 month follow-up. X-ray examination showed that pulmonary vascularity and heart size were improved. CONCLUSION Transcatheter closure of secundum ASD using Amplatzer occluder device with TTE guidance was an efficient, feasible and safe non surgical method. It had a high successful rate of technique and satisfied immediate and short term results.We suggest that the more than 30mm ASD ahould be closured by monitoring of transesophagus echocardiography.

参考文献/References

[1] King TD, Mills Nl. Nonoperative closure of artrial septal defects[J]. Surgery , 1974, 75 (3) : 383- 388.

[2] Sideris EB, Sideris SE, Thanpoulos BD, et al. Transvenous artial septal defect occlusion by the buttoned device[J]. Am J Cardiol, 1990, 66 (4) : 1524- 1526.

[3] Das GS, Voss G, Jarvis G, et al. Experimental atrial septal defect closure with a new , transcatheter,self-centering device[J]. Circulation, 1993, 88 (9) : 1754- 1764.

[4] Hausdorf G, Schneider M, Franzbach B, et al. Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system: initial experience in children [J].Heart, 1996, 75 (1) : 83- 88.

[5] 张玉顺, 贾国良, 何争, 等. 应用Amplatzer 封堵器治疗房间隔缺损[J]. 心脏杂志, 2000, 12 (5) : 379- 381.

[6]Masura J , Gavora P, Formanek A , et al. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: initial human experience[J]. Cathet Cardiovasc Diagn, 1997, 42 (3) : 388- 393.

[7] 戴汝平, 刘延玲, 张戈军, 等. 应用Amplatzer 封堵器介入治疗房间隔缺损疗效评价(附60 例报告). 中华心血管病杂志, 2000,28 (5) : 371.

[8] Thanopoulos BD, Laskari CV , Tsaousis GS, et al. Closure of atrial septal defects with Amplazer occlusion device: priminary results[J]. J Am Coll Cardiol, 1998, 31 (5) : 1110- 1116.

备注/Memo

备注/Memo:
收稿日期：2001-03-21.
更新日期/Last Update: 2001-09-01