老年房间隔缺损患者经导管封堵治疗的可行性及疗效

Feasibility and therapeutic effectiveness of transcatheter closure of secundum atrial septal defect in aged patients

目的 探讨经导管封堵治疗老年房间隔缺损患者的可行性及疗效。方法 19例年龄≥ 6 0岁的老年房间隔缺损患者 ,术前经胸超声测量房间隔缺损直径为 10～ 34(2 4 .4± 8.2 )mm ,其中 3例患者为双孔型房间隔缺损。 11例患者合并心房颤动或阵发性心房颤动。X线胸片示心胸比例均 >0 .5 (0 .5 2～ 0 .70 )。术前心功能 (NYHA分级 )Ⅱ级8例 ,Ⅲ级 9例 ,Ⅳ级 2例。所有患者均在局麻下 ,应用X线透视和经胸心脏超声引导行房间隔缺损封堵术。结果术中测肺动脉平均压力 2 1～ 4 7mmHg(1mmHg=0 .133kPa) ,其中肺动脉平均压力 >2 5mmHg者 16例。所有患者均用Amplatzer房间隔缺损封堵器或国产双盘状封堵器一次封堵治疗成功。所用封堵器直径为 14～ 38mm。 3例双孔型缺损 ,2例用 2 8mm和 32mm封堵器一并封堵 ,另 1例用直径 14mm和直径 2 6mm的封堵器封堵成功。所有患者于术后 5～ 7d行经胸心脏超声检查 ,无残余分流。术后患者心功能明显改善 ,随访 1～ 30个月 ,无封堵器相关的并发症。结论 经导管封堵治疗老年房间隔缺损患者是一种安全有效的方法。

Objective To investigate the feasibility and effectiveness of transcatheter closure of atrial septal defect (ASD) in aged patients.Methods Nineteen patients with secundum atrial septal defect were over 60 years old. The diameter of ASD measured by echocardiography were 10～34(24.4±8.2) mm before intervention. Three patients had double ASDs. Eleven patients were complicated by permanent or paroxysmal atrial fibrillation. The X-ray chest film showed the cardiac-thoracic ratio being higher than 0.5(ranged 0.52～0.70) in all patients. NYHA class was grade Ⅱ in 8 patients, grade Ⅲ in 9 patients and grade Ⅳ in 2 patients. All patients were treated with Amplatzer ASD occluder device or homemade double-disc ASD occluder through the percutaneous procedure under fluoroscopy and transthoracic echocardiography.Results The mean pulmonary artery pressure(mPAP) measured during the procedure was 21～47 mm Hg and was over 25 mm Hg in 16 patients. The Amplatzer occluder or homemade occluder was successfully deployed in all patients. The diameter of occluder was 14～38 mm. For 3 patients with double ASDs, the double ASDs were completely closed using one device in 2 patients and two devices in another patient.No residual shunt was found by the transthoracic echocardiography 5～7 days after the procedure in all patients. The cardiac function improved by Ⅰ～Ⅱ grade after the intervention in all patients. No complication was found during the 1～30 month follow-up period.Conclusion Transcatheter closure of secundum ASD is an efficient and safe method for aged patients.