心导管及经胸小切口两种路径房间隔缺损封堵比较及超声心动图监测的价值

Comparison of occlusion of atrial septal defect with two ways through catheterization and chest small incision and value of echocardiographic monitoring

目的 比较心导管法和经胸小切口法房间隔缺损 (ASD)封堵术的异同和超声心动图监测的价值。方法 心导管法ASD封堵术 111例 ,经胸小切口直接由右房置入封堵器 71例。经食管超声心动图 (TEE)或经胸超声心动图 (TTE)检测缺损大小及边缘状况 ,并指导封堵。结果 心导管法和经胸小切口法封堵的缺损大小、ASD/(ASD +残留间隔 )及封堵器大小分别为 (18.7± 7.5 )mmvs (19.1± 6.1)mm (P >0 .0 5 ) ,0 .44± 0 .13vs0 .5 0± 0 .14 (P <0 .0 5 )和 (2 4.3± 8.0 )mmvs (2 6.4± 8.4)mm (P >0 .0 5 )。心导管法和经胸小切口法缺损一侧缘≤ 5mm和两侧缘之和≤ 10mm者分别为 18.0 %vs 3 2 .4% (P <0 .0 5 )和 5 .4%vs 12 .7% (P >0 .0 5 )。两种方法共封堵双孔及多孔ASD 7例 ,均于较小孔缺损边缘留有少量分流。结论 心导管法可顺利闭合中、小型ASD ,对缺损较大、边缘较短者有一定技术难度 ;经胸小切口法适应证更广 。

Objective To compare the difference and similarity of occlusion of atrial septal defect (ASD) with Amplatzer and DASDO occluders by catheterization and chest small incision methods and their value of echocardiographic monitoring.Methods One hundred and eleven patients with ASD were occluded by catheter method and seventy one patients with ASD were occluded by chest small incision method.The side and edge of ASD were detected,and occlusion was instructed by transesophageal and transthoracic echocardiography.Results The side of ASD,the ratio of ASD and ASD plus residual septa and the occluder side occluded by catheter and incision methods were ( 18.7 ± 7.5 )mm vs ( 19.1 ± 6.1 )mm (P> 0.05 ), 0.44 ± 0.13 vs 0.50 ± 0.14 (P< 0.05 ) and ( 24.3 ± 8.0 )mm vs ( 26.4 ± 8.4 )mm (P> 0.05 ),respectively.Small than and equal to 5 mm of one side of ASD edge,and small than and equal to 10mm of two sides of ASD edge in catheter and incision groups were 18.0% vs 32.4% (P< 0.05 ) and 5.4% vs 12.7% (P> 0.05 ),respectively.Seven cases with two and multiple holes of ASD were closed by two methods,and small shunt was found at the one side of smaller ASD.Conclusions It is easy to close small and middle ASD with catheter method.However,some kind of technological difficulty existes with large and short edge of ASD.The method of small incision through chest has wider indication,which can be a supplement of catheter method.