我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

国产封堵器闭合房间隔缺损过程中的短暂ST段抬高2例(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第6期
页码:
752-756759
栏目:
临床研究
出版日期:
2008-12-25

文章信息/Info

Title:
Transient STsegmentelevation during transcatheter closure of atrial septal defect(ASD) with ASD occluder made in China: A report of two cases
作者:
王显; 胡大一; 孙琪; 谭琛
北京军区总医院心血管内科，北京 100700
Author(s):
WANG Xian;  HU Dayi;  SUN Qi;  TAN Chen
Department of Cardiology,Beijing Military General Hospital， Beijing 100700， China
关键词:
房间隔缺损; 房间隔缺损封堵器; 短暂性ST段抬高
Keywords:
atrial septa defect;  atrial septa defect occluder;  transient STsegmentelevation
分类号:
R542.5
DOI:
-
文献标识码:
A
摘要:
目的 国产房间隔封堵器闭合房间隔缺损的安全性和有效性已得到证实。我们报告在使用国产封堵器闭合房间隔缺损过程中出现的短暂ST段抬高现象2例。方法 适合进行经皮封堵术的房间隔缺损患者35例，使用北京华医圣杰公司生产的房间隔封堵器进行封堵。术前经胸超声充分评估缺损的大小、位置、与周围结构的距离以及房间隔的软硬边缘等，选择封堵器要与缺损的伸展直径相匹配。手术过程在局部麻醉或者基础麻醉下进行，术中使用经胸超声引导。封堵器释放后有效闭合缺损、位置稳定且不影响周边结构视为手术成功。术后3，6，12月进行随访。结果 在35例患者中有2例在封堵器释放过程中，出现短暂性ST段抬高超过2 mV，伴有心绞痛发作。心电图改变和症状发作平均持续时间(4.2±2.2) min，2例心电图改变均发生于II，III和 aVF导联，此过程伴有心率减慢和血压降低。静脉注射硝酸甘油后心电图和症状没有得到即刻改善，但封堵器沿鞘管被收回后心电图立即改善、症状逐渐消失。换用较小型号的封堵器闭合房间隔缺损后，没有引起任何血流动力学异常和短暂性心电图改变。随访3，6，12月没有发现心肌缺血和心绞痛发作。结论 经导管闭合房间隔缺损过程中出现的短暂ST段抬高现象，可能与所选封堵器直径过大，刺激房间隔有关。
Abstract:
AIM The safety and efficacy of atrial septal defect(ASD) occluder(ASDO) made in China for transcatheter closure of ASD have investigated prospectively. We report the phenomenon of transient STsegmentelevation(TSTE) during transcatheter closure of ASD with ASDO made in China in this singlecentre study. METHODS A total of 35 consecutive patients in whom a septal defect occluder (Huayishengjie Inc., Beijing, China) was used to close a clinically significant ASD were included in our study.All procedures performed under basic or local anaesthesia with transthoracic echocardiographic guidance. Interatrial communications were assessed by transthoracic echocardiography(TTE) with reference to size, position in the interatrial septum, proximity to surrounding structures, and adequacy of septal rim. Device selection was based on and matched to the stretched diameter of the communication.Success defined as deployment of device in a stable position to occlude the interatrial communication without inducing functional abnormality or anatomical obstruction. Occlusion status determined by TTE during procedure and the follow up of the study at 3, 6, and 12 months. RESULTS In 2 of the 35 patients from our centre, a transient STsegmentelevation greater than 0.2 mV was recorded and angina pectoris occurred during the deployment of the device.The ECG changes and the symptoms started abruptly and lasted for (4.2±2.2) min. All the ECG changes occurred in lead II, III, and aVF.The association between the heart rate, blood pressure and the ECG changes was described. The bradycardia and hypotension were seen during STsegmentelevation in these two patients. The administration of intravenous nitroglycerin was performed, the symptoms and ECG changes didn’t recovered immediately. When the devices were retrieved by withdrawing it into the sheath by traction on the delivery wire, the symptoms were gradually eliminated and ECG changes recuperated immediately. No haemodynamic derangement or transient ECG changes occurred after the larger diameter devices were exchanged. During the followup of the study at 3, 6, and 12 months these two patients showed no further signs of myocardial ischemia and were free of episodes of angina pectoris. CONCLUSION The phenomenon of STsegment elevation during transcatheter closure of ASD may be caused by the mechanical effects of the larger diameter ASDO.

参考文献/References

［1］ Sideris EB, Sideris SE, Thanopoulos BD, et al. Transvenous atrial septal defect occlusion by the buttoned device［J］. Am J Cardiol, 1990, 66(20):1524-1526.

［2］ 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.

［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(4 pt 1):1754-1764.

［4］ de la Torre Hernández JM, FernándezValls M, Vázquez de Prada JA, et al. ST changes during percutaneous closure of atrial septal defect［J］. Rev Esp Cardiol, 2001, 54(12):1446-1447.

［5］ Chan KC, Godman MJ, Walsh K, et al. Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience［J］. Heart, 1999, 82(3):300-306.

［6］ de la Torre Hernández JM, FernándezValls M, Vázquez de Prada JA, et al. Transient ST Elevation: a finding that may be frequent in percutaneous atrial septal defect closure in adults［J］. Rev Esp Cardiol, 2002, 55(6):686-688.

［7］ Calkins H, Langberg J, Sousa J, et al. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients［J］. Circulation, 1992, 85(4):1337-1346.

［8］ Lesh MD, Coggins DL, Ports TA. Coronary air embolism complicating transseptal radiofrequency ablation of left freewall accessory pathways［J］. Pacing Clin Electrophysiol, 1992, 15(8):1105-1108.

［9］ Natale A, Pisano E, Shewchik J, et al. First human experience with pulmonary vein isolation using a throughtheballoon circumferential ultrasound ablation system for recurrent atrial fibrillation［J］. Circulation, 2000,102(16):1879-1882.

［10］Simon RD, Gill JS. Coronary ischemia induced by radiofrequency ablation in the left atrium［J］ . J Cardiovasc Electrophysiol, 2003, 14(2):186-190.

［11］Benito Bartolomé F, Sánchez FernándezBernal C, Jiménez Casso S. Coronary ischemia during radiofrequency ablation of left lateral accessory pathway in an infant［J］. Rev Esp Cardiol, 1998, 51(4):343-345.

［12］Tebbe U, Neuhaus KL, Kreuzer H. Slow flow in the coronary system and ST elevation in the ECG in left atrium catheterization［J］. Z Kardiol, 1984, 73(12):789-791.

［13］Kawano H, Okada R, Yano K. Histological study on the distribution of autonomic nerves in the human heart［J］. Heart Vessels, 2003, 18(1):32-39.

［14］Arora RC, Waldmann M, Hopkins DA, et al. Porcine intrinsic cardiac ganglia［J］. Anat Rec A Discov Mol Cell Evol Bial, 2003, 217(1):249-258.

［15］Burkholder T, Chambers M, Hotmire K, et al. Gross and microscopic anatomy of the vagal innervation of the rat heart［J］. Anat Rec, 1992, 232(3):444-452.

［16］Arita T, Kubota S, Okamoto K, et al. BezoldJarischlike reflex during Brockenbrough’s procedure for radiofrequency catheter ablation of focal left atrial fibrillation: report of two cases［J］. J Interv Card Electrophysiol, 2003, 8(3):195-202.

备注/Memo

备注/Memo:
收稿日期：2008-03-04.基金项目：国家卫生部“十年百项”推广项目基金资助（200713） 通讯作者：王显，主任医师，主要从事介入心脏病学、预防心脏病学和中西医结合心脏病学研究Email:WX0515@hotmail.com
更新日期/Last Update: 2009-03-24