小儿先天性左向右分流型心脏病的介入治疗

Transcatheter closure of congenital heart diseases with left-to-right shunt in children and infants

目的 评价应用Amplatzer封堵器进行介入治疗小儿先天性心脏病的效果、安全性。方法 超声心动图确诊的动脉导管未闭 (PDA)、房间隔缺损 (ASD)及膜部室间隔缺损 (膜部VSD)患者 4 9例 ,在透视或 /和经胸超声心动图 (TTE)指引下置入Amplatzer封堵器 ,术后 2 4小时 ,1、3、6、12个月及以后每年分别TTE、ECG和X线胸片检查评价治疗效果。结果 16例ASD球囊测量缺损伸展径为 13～ 2 8(平均 19 3± 4 9)mm ,选择封堵器直径 13～ 30 (平均 2 0 6± 5 1)mm ;2 5例PDA造影测量PDA最窄处直径为 2～ 7 7(平均 3 9± 1 5 )mm ,选择封堵器直径 4～ 12 (平均 6 6± 1 9)mm ;8例膜部VSD造影测量VSD直径 3 4～ 8(平均 4 7± 2 3)mm ,选择封堵器直径 6～ 10 (平均 7 8±1 7)mm。技术成功率为 10 0 % ,术中未发生任何并发症 ,无急诊手术病例。术后即刻造影或TTE显示 10例存在残余分流 ,3个月TTE示所有病例无残余分流和再通 ,心室内径均有不同程度的缩小 ,肺动脉压下降。结论 应用Amplatzer封堵器介入治疗小儿先天性心脏病 ,具有操作简单、安全、损伤小、成功率高等优点 ,适合于儿童继发孔型ASD。

Objective To evaluate the safety and feasiblity of transcatheter closure procedure for congential heart diseases in chlildren by Amplatzer occluder.Methods 49 patients,including 25 patent ductus arteriosus(PDA),16atrial septal defects(ASD) and 8 perimembranous ventricular septal defects(VSD),comfirmed by transthoracic echocardiography (TTE),were enrolled into the present study.Amplatzer occluder device was implanted percutaneously.TTE was used.TTE?ECG and X-ray examination were applied to evaluate efficacy at the time interval of 24h,1 mon,3 mon,6 mon,1 year and yearly after the procedure.Results The mean ballon stretched diameter of the ASD was 19.3±4.9(13-28)mm,the mean narrowest diameter(cardioangiography)were 3.9±1.5(2-7.7)mm at PDA and 4.7±2.3(3.4-8)mm at VSD.The mean diameter of the occluder selected were 20.6±5.1(13-30)mm at ASD,6.6±1.9(4～12)mm at PDA and 7.8±1.7(6-10)mm at VSD respectively.The success rate of the procedure was 100%.No complications including those in need of emergent surgery occurred during the procedure.Very small residual shunt immediately after the procedure was seen in 10 cases,and disappeared after 3 months during follow-up.Pulmonary pressure and cardiac dimension decreased significantly during follow-up.Conclusion Transcather closure of secundum ASD,PDA and membranous VSD in children using the Amplatzer occluder is much less invasive but feasible with high success rate of procedure.