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|本期目录/Table of Contents|

新型封堵器经胸封堵房间隔缺损386例

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第1期
页码:
91-95
栏目:
临床研究
出版日期:
2010-01-04

文章信息/Info

Title:
Transthoracic closure of atrial septal defect with a new occluder device: report of 386 cases
作者:
康云帆1杨光2蔡振杰13俞世强3
1.陕西省人民医院心脏外科,陕西 西安 710068;2.西安高新医院心脏外科, 陕西 西安 710038;3.第四军医大学西京医院心脏外科,陕西 西安 710032
Author(s):
KANG Yun-fan1 YANG Guang2 CAI Zhen-jie13 Yu Shi-qiang3
1.Department of Cardiosurgery, People’s Hospital of Shaanxi Province, Xi’an 710068, China; 2.Department of Cardiosurgery, Gaoxin Hospital, Xi’an 710038, Shaanxi, China; 3.Department of Cardiosurgery, Xijing Hospital, Fourth Military Medical University, Xi
关键词:
房间隔缺损经胸封堵封堵器
Keywords:
atrial septal defect transthoracic closure occluder
分类号:
R542.5
DOI:
-
文献标识码:
A
摘要:
目的: 探讨新型封堵器经胸关闭房间隔缺损的有效性和安全性。方法: 设计一种新型的封堵器和传送系统:封堵器由外鞘管、内鞘管、传送杆经第4肋间和右侧房壁送出,封堵房缺。通过这种经胸方式共治疗患者386例,年龄1~79(平均11.8)岁,分析临床资料。结果: 房缺平均直径为20.4(4~38)mm,成功植入封堵器382例,因房间隔多发缺损植入2个封堵器22例。整个手术时间为35~62(平均44±7.4)min;术后24 h经胸B超证实手术成功率为98.9%;植入术中封堵器脱落1例,因此取出封堵器改用手术方法封闭房缺;另1例患者房缺成功封闭,术后当晚发生颅内出血,经神经外科治疗成功康复。结论: 对于大多数房缺患者,经胸封闭房缺是有效且安全的,其操作也较为简便。
Abstract:
AIM: To investigate the effectiveness and safety of transthoracic closure of atrial septal defects (ASD) in the treatment of ASD. METHODS: A new kind of occluder device and its delivery system were designed. The occluder device was delivered by an outer sheath, an inner sheath and a delivery rod through the fourth intercostal space and right atrial wall to occlude the ASD. A total of 386 patients (mean age 11.8 years, range: 1-79 years) were treated using this transthoracic procedure, and clinical data were analyzed. RESULTS: Mean stretched diameter of ASD was 20.4 (range: 4-38 mm). Occluder devices were successfully implanted in 382 patients, and 22 patients received two devices because of multiple fenestrations in the atrial septum. The entire procedure time varied from 35 to 62 (44±7.4)min and the intracardiac maneuver time varied from 9 to 17 (12±1.9)min. Transthoracic echocardiography showed that the success rate of total occlusion was 98.9% 24 h after implantation. Device embolization during implantation occurred in one case. The device was retrieved and the ASD was closed surgically. Cerebral bleeding occurred at night in one successfully occluded ASD case and the patient was effectively treated neurosurgically. CONCLUSION: Transthoracic closure of ASD is effective and safe with surgical ease in the treatment of the majority of ASD patients.

参考文献/References

[1] King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defects. Nonoperative closure during cardial catheterization[J]. JAMA, 1976, 235(23):2506-2509.

[2] Sievert H, Babic UU, Hausdorf G, et al. Transcatheter closure of atrial septal defect and patent formen ovale with ASDOS device (a multi-institutional European trial)[J]. Am J Cardiol, 1998, 82(11):1405-1413.

[3] Hijazi ZM, Cao QL, Patel H, et al. Transcatheter closure of atrial communications using the AmplatzerTM septal Occluder[J]. J Intervent Cardiol, 1999, 12(1): 51-58.

[4] Huang TC, Hsieh KS, Lin CC, et al. Clinical results of percutaneous closure of large secundum atrial septal defects in children using the Amplatzer septal occluder[J]. Heart Vessels, 2008, 23(3):187-192.

[5] Wang JK, Tsai SK, Wu MH, et al. Short- and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer Septal Occluder[J]. Am Heart J, 2004, 148(3):511-517.

[6] Bohm J, Bittigau K, Kohler F, et al. Surgical removal of atrial septal defect occlusion system-device[J]. Eur J Cardiothorac Surg, 1997, 12(6):869-872.

[7] Berdat PA, Chatterjee T, Pfammatter JP, et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale[J]. J Thoracic Cardiovasc Surg, 2000, 120(6):1034-1039.

[8] Carlson KM, Justino H, O’Brien RE, et al. Transcatheter atrial septal defect closure: modified balloon sizing technique to avoid overstretching the defect and oversizing the Amplatzer septal occluder[J]. Catheter Cardiovasc Interv, 2005, 66(3):390-396.

备注/Memo

备注/Memo:
收稿日期:2008-5-13.通讯作者:康云帆,主治医师,博士,主要从事先天性心脏病的外科治疗Email:kangyf@fmmu.edu.cn
更新日期/Last Update: 2010-01-05