42～46mm封堵器介入治疗巨大房间隔缺损的疗效及经验

Effects and experiences of transcatheter occlusion of larger atrial septal defect with 42～46 mm occluder

目的:评价42～46mm国产封堵器介入治疗巨大继发孔型房间隔缺损的效果和安全性。方法:全组37例,年龄20～58(36士14)岁。术前超声心动图检查ASD最大直径34～42(37±3)mm,5例(14%)缺损的所有边缘均≥5mm,13例(35%)缺损的前缘径不足0～4mm,19例(51%)缺损的前缘径、后缘径或下腔静脉缘径不足2～4mm。其中18例有轻度肺动脉高压,12例有轻～中度肺动脉高压,4例中度肺动脉高压。5例并发心房纤颤。所有病例均经导管置入特制国产ASD封堵器。术后3d、1～6个月分别行经胸超声心动图(TTE)、心电图及X线检查。结果:37例应用的封堵器大小42mm16个、44mm14个,46mm7个。36例均一次封堵成功,1例40mm巨大ASD,用46mm封堵器关闭成功后,反复牵拉封堵器脱落,改用48mm封堵器封堵成功。术中3例出现一过性Ⅱ度房室传导阻滞,用阿托品对症处理后恢复。手术即刻,TTE显示6例(17%)有微～小量残余分流,完全堵闭率83%(29/36);术后3d,2例(6%)有微量残余分流。1～6个月复查TTE,34例(94%)心脏大小恢复正常,2例(6%)并发心房纤颤患者心脏不同程度的缩小,无1例有残余分流。1年后随访15例,未发现主动脉壁穿孔和心脏穿孔、心包积液。结论:应用42～46mm国产封堵器介入治疗巨大继发孔型房间隔缺损,亦具有操作简便、安全、技术成功率高及封堵效果好等优点。

AIM: To evaluate the effects and safety of transcatherter occlusion of larger atrial septal defect (ASD) with 42~46 mm domestic-made occluder. METHODS: Total 37 patients, aged from 20 to 58 years old (average aged of 36±14, were investingated. The largest diameter measured by echocardiography was from 34 to 42 mm (averaged of 37±3 mm). 5 cases (12%) with the distance of defect to all rims more than 5 mm, 13 cases (35%) with anterior rim less than 4 mm, 19 cases (51%) with anterior or posterior rim and/or inferior vein less than 4 mm. In all patients, 18 cases with slightly pulmonary hypertension, 12 cases with mild to medium pulmonary hypertension and 4 cases with medium pulmonary hypertension. 5 cases with atrial fibrillation. All patients underwent transcatheter occlusion of ASD by specially domestic-made occluder. Transthoracic echocardiography (TTE, ECG and X-ray were taken at post-occlusion of 3 d, 1~6 months follow-up. RESULTS: Implantment of 42 mm, 44 mm and 46 mm occluder was in 16, 14, and 7 cases, respectively. 36 cases were successfully implanted with once try. One case with 40 mm ASD, was firstly successfully occluded by 46 mm occluder, but was finally fell off due to drag repeatedly. 3 cases happened transient second-degree atrioventricular block (AVB) during procedure, and AVB was recovered treated with Atropine. Immediately after occlusion, 6 cases (17%) had trivial to mild residual shunt by TEE examining. Complete occlusion rate was 83% (29/36). 3 d after occlusion, 2 cases (6%) had trivial shunt. During 1~6 months follow-up, examined by TEE, 34 cases (94%) heart size recovered to normal; 2 cases (6%) associated with atrial fibrillation, heart size reduced at some degree; None was seen residual shunt. 15 cases had taken 1 year follow-up, of whom none had found aorta perforation, heart perforation and pericardial effusion. CONCLUSION: Transcatheter occlusion of larger ASD with 42~46 mm domestic-made occluder also have opportunity of easy to operate, safty, high technique successful rate and good occlusion results.