边缘不足房间隔缺损的介入治疗评价

Transcatheter closure of secundum atrial septal defects associated with deficient rims.

目的:探讨用Amplatzer或国产封堵器介入治疗部分边缘缺乏或边缘<5mm房间隔缺损的可行性。方法:ASD伴有部分边缘缺乏或边缘<5mm者176(男72,女104)例,缺损的前缘径0～4mm的患者171例,其中78例仅缺损的前缘径单独不足,43例同时并发缺损的后缘径2～4mm,38例同时并发后缘径不足和下腔静脉缘径2～4mm,12例并发后缘径、下腔静脉缘径不足和后上缘径2～4mm。4例缺损的上腔静脉缘径仅为0～4mm;2例缺损的下腔静脉缘径仅为2mm。同期有309例ASD均伴有足够边缘(>5mm)。结果:176例应用的封堵器大小为6～40(22±11)mm,2例用双伞封堵。术后即刻超声心动图显示完全堵闭率91%(161/176),15例(9%)有微～小量残余分流,术后3d10例(6%)有微～小量残余分流。随访6个月,2例(1%)有微量残余分流,无其他并发症。与同期足够边缘的309例比较,手术成功率和残余分流发生率无显著差别(P>0.05)。结论:用Amplatzer或国产ASD封堵器可以成功地介入治疗伴有前、后、下缘或上缘边径不足5mm的房间隔缺损,其远期临床效果尚待观察。

AIM:To evaluate the feasibility of transcatheter closure of secundum atrial septal defects (ASDs) associated with deficient rims (<5 mm) using the Amplatzer septal occluder (ASO) or domestic-made occluder. METHODS:176 patients underwent attempted transcatheter closure of a ASDs . 171 cases associated with deficient anterior rim of 0 to 4 mm , 78 cases with simple deficient anterior rim among them, 43 cases with deficient posterior rim of 2 to 4 mm, 38 cases with deficient posterior and inferior rim 2 to 4 mm. 12 cases with deficient posterior and inferior rim and a posterior-superior rim of 2 to 4 mm . 4 cases associated with superior rim of 0 to 4 mm. 2 cases associated with inferior rim of 0 to 4 mm. 4 cases deficient anterior rim of 0 to 4 mm . 309 patients with sufficient rims (>5 mm) who underwent closure served as controls. RESULTS: The mean selected diameter of the occluder was 22±11 mm ( ranged from 6~40 mm ). In two cases with double ASD, occluders, were used. Of 178 patients with deficient rims, 161 (91%) had immediate complete closure, trivial to small residual shunts were found in 15 cases(9%, trivial to small residual shunts were found in 10 cases(9%) 3 days after the procedure, trivial shunts were found in 2 cases(1%) at 6 month follow-up and no other complications were encountered either during or after the closure procedure . There were no differences between the 2 groups in the success rate of placement of ASDs occluder and residual shunts. Transcatheter closure of secundum ASD using Amplatzer occluder device was an efficient nonsurgical method for patients above 40 years old. CONCLUSION: Transcatheter closure of ASDs associated with anterior, inferior, posterior or superior rims is feasible using an ASO or domestic-made occluder. Long-term follow-up data are still needed to assess long-term safety and efficacy.