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边缘不足房间隔缺损的介入治疗评价(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第3期
页码:
265-267
栏目:
介入治疗
出版日期:
2005-05-05

文章信息/Info

Title:
Transcatheter closure of secundum atrial septal defects associated with deficient rims.
作者:
张玉顺1; 代政学1; 王垒2; 李寰1; 张军1; 李军1
1.第四军医大学西京医院, 2.西安市儿童医院, 陕西 西安 710032
Author(s):
ZHANG Yushun ; DAI Zhengxue;  WANG Lei;  LI Huan;  ZHANG Jun;  LI Jun
Department of Cardiology,Xijing Hopital， Fourth Military Medical University,Xi′an， Shaanxi 710032,China
关键词:
房间隔缺损;  介入性治疗; 封堵器
Keywords:
atrial septal defects;  transcatheter closure; occluders
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 探讨用Amplatzer或国产封堵器介入治疗部分边缘缺乏或边缘<5 mm房间隔缺损的可行性。方法 ASD伴有部分边缘缺乏或边缘<5 mm者176（男72，女104）例，缺损的前缘径0~4 mm的患者171例，其中78例仅缺损的前缘径单独不足，43例同时并发缺损的后缘径2~4 mm，38例同时并发后缘径不足和下腔静脉缘径2~4 mm，12例并发后缘径、下腔静脉缘径不足和后上缘径2~4 mm。4例缺损的上腔静脉缘径仅为0~4 mm；2例缺损的下腔静脉缘径仅为2 mm。同期有309例ASD均伴有足够边缘(>5 mm)。结果 176例应用的封堵器大小为6~40(22±11) mm，2例用双伞封堵。术后即刻超声心动图显示完全堵闭率91%(161／176)，15例(9％)有微~小量残余分流，术后3 d 10例(6％)有微~小量残余分流。随访6个月, 2例(1％)有微量残余分流，无其他并发症。与同期足够边缘的309例比较，手术成功率和残余分流发生率无显著差别(P>0.05)。结论 用Amplatzer或国产ASD封堵器可以成功地介入治疗伴有前、后、下缘或上缘边径不足5 mm的房间隔缺损，其远期临床效果尚待观察。
Abstract:
AIM To evaluate the feasibility of transcatheter closure of secundum atrial septal defects (ASDs) associated with deficient rims (<5 mm) using the Amplatzer septal occluder (ASO) or domesticmade occluder. METHODS 176 patients underwent attempted transcatheter closure of a ASDs . 171 cases associated with deficient anterior rim of 0 to 4 mm , 78 cases with simple deficient anterior rim among them, 43 cases with deficient posterior rim of 2 to 4 mm, 38 cases with deficient posterior and inferior rim 2 to 4 mm. 12 cases with deficient posterior and inferior rim and a posteriorsuperior rim of 2 to 4 mm . 4 cases associated with superior rim of 0 to 4 mm. 2 cases associated with inferior rim of 0 to 4 mm. 4 cases deficient anterior rim of 0 to 4 mm . 309 patients with sufficient rims (>5 mm) who underwent closure served as controls. RESULTS The mean selected diameter of the occluder was 22±11 mm ( ranged from 6~40 mm ). In two cases with double ASD, occluders, were used. Of 178 patients with deficient rims, 161 (91%) had immediate complete closure, trivial to small residual shunts were found in 15 cases(9%), trivial to small residual shunts were found in 10 cases(9%) 3 days after the procedure, trivial shunts were found in 2 cases(1%) at 6 month followup and no other complications were encountered either during or after the closure procedure . There were no differences between the 2 groups in the success rate of placement of ASDs occluder and residual shunts. Transcatheter closure of secundum ASD using Amplatzer occluder device was an efficient nonsurgical method for patients above 40 years old. CONCLUSION Transcatheter closure of ASDs associated with anterior, inferior, posterior or superior rims is feasible using an ASO or domesticmade occluder. Longterm followup data are still needed to assess longterm safety and efficacy.

参考文献/References

［1］ Fisher G, Kramer HH, Stieh J, et al. Transcatheter closure of secundum atrial septal defects with new selfcentering Amplatzer Septal Occluder［J］. Eur Heart J, 1999,20(7):541-549.

［2］Berger F, Ewert P, Abdulkhaliq H, et al. Percutaneous closure of large atrial septal defects with the Amplatzer septal occluder: Technical overkill or recommendable treatment? ［J］. J Interven Cardiol,2001,14(1):63-67.

［3］Rao PS, Langhough R. Relationship of echocardiographic,shunt flow and angiographic size of the stretched diameter of atrial septal defect［J］. Am Heart J, 1991,122:505-508.

［4］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,2000，12:379-381.

［5］Hijazi ZM, Cao Q, Patel HT, et al. Transesophageal echocardiogrophic results of catheter closure of atrial septal defect in children and adults using the Amplatzer device［J］. Am J Cardiol,2000,85:1387-1390.

［6］徐立，戴汝平，刘延玲, 等. Amplatzer法房间隔缺损封堵术——经食道超声心动图测量选择封堵器的可行性［J］. 中华心血管病杂志,2001,29（5）：297-299.

［7］Minich LL, Snider AR. Echocardiographic guidance during placement of the buttoneddisk devence for atrial septal defect closure［J］. Echocardiography,1993,10:567-572.

［8］Ishii M, Kato H, Inone O, et al. Biplane transesophageal echoDoppler studies of atrial septal defects: quantitative evaluation and monitoring for transcatheter closure［J］. Am Heart J, 1993,125:1363-1368.

［9］Godart F, Rey C , Francart C, et al. Twodimensional echocardiographic and color doppler measurements of atrial septal defect,and comparison with the ballonstretched diameter［J］. Am J Cardiol, 1993,72:1095-1097.

备注/Memo

备注/Memo:
收稿日期：2004-12-30.基金项目：陕西省自然科学基金资助(项目编号:2003C2053)
更新日期/Last Update: 2010-01-05