经导管置入Amplatzer封堵器治疗多孔的房间隔缺损及其初步疗效评价

Transcatheter closure of multiple secundum atrial septal defects using Amplatzer septal occluder: a preliminary result of clinical application

目的 经导管置入Amplatzer封堵器治疗多孔的继发孔型房间隔缺损 (ASD) ,并对其疗效进行初步评价。方法 8例多孔ASD病人 ,男性 1例 ,女性 7例 ,年龄 11～ 5 6岁 (36 6± 17 3)岁 ,体重 2 8～ 90 (6 0 1± 19 5kg)。所有病例均于X线透视和术中超声心动图监测下置入一个Amplatzer封堵器同时闭合大小缺损。术后重复TTE、ECG及X线平片检查以评价疗效。结果 8例患者封堵器置入均获成功。除 1例术中发生短暂性ST段抬高外 ,无其他严重并发症。早期 4例根据球囊测量值选择封堵器 ,余 4例根据TEE测量值选择封堵器 ,采用封堵器直径为 13～ 34 (2 2 4± 7 0mm)。术后即刻TEE/TTE检查显示 8例患者大缺损均获完全闭合 ,但有 5例 (6 2 5 % )患者其小缺损存在微量到少量残余分流。术后 2 4h复查提示 3例 (37 5 % )仍存在少量分流。近期随访中TTE检查发现 2例 (2 5 % )患者仍存在少量残余分流 ,但同期TTE检查提示其右心室舒张末径 (RVEDD)均较术前明显回缩 ,基本恢复正常水平。结论 经导管置入Amplatzer封堵器治疗多孔的ASD是一安全有效的方法 ,近期疗效满意 ,中远期疗效尚需进一步观察。

Objective To evaluate efficiency and safety of transcatheter closure of multiple secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) Methods There were 8 patients with multiple ASDs (1 male, and 7 female) The mean age is 36 6±17 3 years(ranging from11 to 56 years), and the mean weight is 60 1±19 5 kg (ranging from 28 to 90 kg) Guided by X ray fluoroscopy and echocardiography, one atrial septal defect was implanted to close both bigger defect and smaller one in all cases Transthoracic echocardiography (TTE), ECG, X ray examination were repeated after the procedures as follow up to evaluate the safety and efficiency Results The placement of the occluders were successful in all 8 patients There were 1 case of transient ST segment elevating during operation, and there was no mortality or emergent surgery 4 occluders were selected by balloon stretched diameter, and 4 on transesophageal echocardiography (TEE) measured diameter The mean diameter of the occluders used was 22 4±7 0 mm (ranging from 13 to 34 mm) Immediately after the procedures, TEE/TTE confirmed that the bigger defects were occluded completely in all cases, but there were trial or small residual shunts of small defects in 5 cases (62 5%) The residual shunts were present in 3 cases(37 5%) 24 h after the procedure There were still 2 cases (25%) with residual shunt during short time flow up,but the RVEDDs were decreased to normal Conclusion Transcatheter closure of multiple secundum ASDs using Amplatzer septal occluder is safe and efficient, and the long time follow up remains to be