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42~46 mm封堵器介入治疗巨大房间隔缺损的疗效及经验(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第3期
页码:
270-272
栏目:
介入治疗
出版日期:
2005-05-05

文章信息/Info

Title:
Effects and experiences of transcatheter occlusion of larger atrial septal defect with 42~46 mm occluder
作者:
张玉顺1; 李 寰1; 代政学1; 张 军2; 李 军2
第四军医大学西京医院：1.心脏内科，2.超声诊断科, 陕西 西安710032
Author(s):
ZHANG Yushun1;  LI Huan1;  DAI Zhengxue1;  ZHANG Jun2;  LI Jun2
1.Department of Cardiology, 2.Department of Echocardiography, Xijing Hospital, Fourth Military Medical University, Xi’an， Shaanxi 710032
关键词:
房间隔缺损;  介入治疗; 封堵器
Keywords:
atrial septal defect;  interventional therapy;  occluder
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 评价42~46 mm国产封堵器介入治疗巨大继发孔型房间隔缺损的效果和安全性。方法 全组37例，年龄20~58(36士14)岁。术前超声心动图检查ASD最大直径34~42(37±3)mm，5例（14%）缺损的所有边缘均≥5 mm，13例(35％)缺损的前缘径不足0~4 mm，19例(51％)缺损的前缘径、后缘径或下腔静脉缘径不足2~4 mm。其中18例有轻度肺动脉高压，12例有轻~中度肺动脉高压，4例中度肺动脉高压。5例并发心房纤颤。所有病例均经导管置入特制国产ASD封堵器。术后3 d、1~6个月分别行经胸超声心动图(TTE)、心电图及X线检查。结果 37例应用的封堵器大小42 mm 16个、44 mm 14个，46 mm 7个。36例均一次封堵成功，1例40 mm巨大ASD，用46 mm封堵器关闭成功后，反复牵拉封堵器脱落，改用48 mm封堵器封堵成功。术中3例出现一过性Ⅱ度房室传导阻滞，用阿托品对症处理后恢复。手术即刻，TTE显示6例(17％)有微~小量残余分流，完全堵闭率83%(29／36)；术后3 d，2例(6％)有微量残余分流。1~6个月复查TTE，34例（94%）心脏大小恢复正常，2例（6%）并发心房纤颤患者心脏不同程度的缩小，无1例有残余分流。1年后随访15例，未发现主动脉壁穿孔和心脏穿孔、心包积液。结论 应用42~46 mm国产封堵器介入治疗巨大继发孔型房间隔缺损，亦具有操作简便、安全、技术成功率高及封堵效果好等优点。
Abstract:
AIM To evaluate the effects and safety of transcatherter occlusion of larger atrial septal defect (ASD) with 42~46 mm domesticmade occluder. METHODS Total 37 patients, aged from 20 to 58 years old (average aged of 36±14), were investingated. The largest diameter measured by echocardiography was from 34 to 42 mm (averaged of 37±3 mm). 5 cases (12%) with the distance of defect to all rims more than 5 mm, 13 cases (35%) with anterior rim less than 4 mm, 19 cases (51%) with anterior or posterior rim and/or inferior vein less than 4 mm. In all patients, 18 cases with slightly pulmonary hypertension, 12 cases with mild to medium pulmonary hypertension and 4 cases with medium pulmonary hypertension. 5 cases with atrial fibrillation. All patients underwent transcatheter occlusion of ASD by specially domesticmade occluder. Transthoracic echocardiography (TTE), ECG and Xray were taken at postocclusion of 3 d, 1~6 months followup. RESULTS Implantment of 42 mm, 44 mm and 46 mm occluder was in 16, 14, and 7 cases, respectively. 36 cases were successfully implanted with once try. One case with 40 mm ASD, was firstly successfully occluded by 46 mm occluder, but was finally fell off due to drag repeatedly. 3 cases happened transient seconddegree atrioventricular block (AVB) during procedure, and AVB was recovered treated with Atropine. Immediately after occlusion, 6 cases (17%) had trivial to mild residual shunt by TEE examining. Complete occlusion rate was 83% (29/36). 3 d after occlusion, 2 cases (6%) had trivial shunt. During 1~6 months followup, examined by TEE, 34 cases (94%) heart size recovered to normal; 2 cases (6%) associated with atrial fibrillation, heart size reduced at some degree; None was seen residual shunt. 15 cases had taken 1 year followup, of whom none had found aorta perforation, heart perforation and pericardial effusion. CONCLUSION Transcatheter occlusion of larger ASD with 42~46 mm domesticmade occluder also have opportunity of easy to operate, safty, high technique successful rate and good occlusion results.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2004-12-26.
更新日期/Last Update: 2010-01-05