应用Amplatzer封堵器介入治疗房间隔缺损疗效评价(附60例报告)

Clinical application of Amplatzer septal occluder device for transcatheter closure of secundum atrial septal defect: a report of 60 cases

目的 评价经导管置入Amplatzer封堵器治疗继发孔型房间隔缺损 (ASD)的治疗效果。方法 全组 6 0例 ,年龄 5～ 5 3(31 0 0± 12 31)岁 ,体重 18～ 79(5 1 19± 12 12 )kg ,术前经食管超声心动图 (TEE)检查示ASD直径平均为 6～ 2 8(18 14± 6 18)mm。所有病例均在透视及食管超声心动图监视下经导管置入Amplatzer封堵器封堵ASD。 3例有大小紧邻的两个房间隔缺损存在 ,采用较大封堵器 ,一并封堵两个缺损。术后 2 4小时、1月、3月及 1年分别行经胸超声心动图 (TTE)、心电图及X线检查评价治疗效果。结果 6 0例ASD直径的球囊测量值为 8～ 32 (2 1 42± 6 11)mm ,选择的封堵器直径为10～ 34 (2 3 12± 5 72 )mm。 6 0例封堵器置入均获得成功 ,技术成功率为 10 0 % ,术中未发生任何重要并发症 ,无急诊手术病例。术后即刻TEE显示 10例 (16 7% )存在微量至少量残余分流。术后 2 4小时行TTE检查示 8例 (13 3% ,包括 3例多发ASD)残余少量左向右分流 ;术后 1月TTE示 6例 (10 % ,包括 1例多发ASD)存在少量分流。 40例完成 3月随访 ,除 1例 (2 5 % )外 ,TTE显示ASD完全闭合 ,无残余分流 ;10例完成术后 1年随访 ,未见残余分流及再通。X线检查 :全部显示肺血减少、右心房、室缩小。结论 经导管置入Amplatzer封?

Objective To evaluate the efficiency of transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer occluder device Methods Sixty patients with ASD were treated by transcatheter closure of ASD with Amplatzer occluder device. The mean age of patients was 31 00±12 31 years (ranged from 5 to 53 years) and the mean weight was 51 19±12 12 kg (ranged from 18 to 79 kg). The mean diameter of ASD was 18 14±6 18 mm (ranged from 6 to 28 mm) shown by transesophageal echocardiography (TEE) before interventions. Three cases had double ASD. Each case was treated with Amplatzer occluder device through the percutaneous procedure under fluoroscopy and TEE. After the procedure, TEE were performed immediately to find whether there any residual shunt remained. Transthoracic echocardiography (TTE), ECG and X ray examination were done 24 hour, 1 month, 3 month and 1 year after the procedure to evaluate the efficiency. Results The mean balloon stretched diameter of the ASDs was 21 42±6 11 mm (ranged from 8 to 32 mm). The mean diameter of the occluder selected was 23 12±5 72 mm (ranged from 10 to 34 mm). The success rate of placement of Amplatzer occluder was 100%. No complications occurred during the procedure, and no one needed for emergecy surgery. For each of the 3 cases with double ASD, a larger device was used for closing both of the bigger ASD and the smaller one with good results. Trivial to small residual shunts were found in 10 cases (16 7%) immediately after the procedure, in 8 cases (13 3%, including 3 cases with multiple ASD) 24 hour, and in 6 cases (10%, including 1 case with multiple ASD) 1 month after the procedure. A 3 month follow up was completed in forty patients and no residual shunt was found except in 1 (2 5%). Ten patients carried out 1 year follow up and no residual shunt and recanalization were found. X ray examination showed that both pulmonary vascularity and heart size were improved. Conclusions Transcatheter closure of secundum ASD using Amplatzer septal occluder device is an efficient nonsurgical method for patients of any age group. The operation is simple and safe with a high success rate of placement and a good occlusion effect. The long term follow up remains to be studied.