Amplatzer封堵器治疗大孔房间隔缺损的临床应用

Clinical application of transcatheter closure of large atrial septum secundum defect with Amplatzer occluder

目的探讨经导管Amplatzer房间隔封堵器(ASO)治疗大孔房间隔缺损(ASD)的技术方法、疗效和安全性.方法选择经胸超声心动图确诊的大孔ASD(球囊伸展径≥25 mm)患者74例,男19例,女55例,平均年龄为34.9岁.并行经食道超声评价缺损大小及周边组织.堵闭前肺动脉压为(31.0±8.5)mm Hg(1 mm Hg=0.133 kPa),体/肺循环比值为1.8±0.3.所有患者均在透视及食道或经胸超声引导下经导管置入堵闭ASD,对部分ASD残端薄弱者采用改良操作技术完成封堵.结果ASD伸展径为(29.7±2.9)mm.72例封堵成功,技术成功率为97%.手术透视时间为4～56 min,平均为14 min.术后肺动脉压降至(19.0±6.7)mm Hg,超声监护示5例仍存少量残余分流(≤4 mm).1例在术后2 h出现心包填塞,紧急心包穿刺抽液后恢复.术中出现心律失常7例.失败2例均为缺损后缘缺乏,其中1例ASO脱落,另1例为ASO不能释放到位.本组随访1个月～3.4年,超声心动图示ASO位置稳定,仅1例仍存残余分流(≤2 mm).结论经导管ASO治疗大孔ASD疗效可靠,但仍有一定并发症,应进一步完善技术,规范操作程序.

Objective To elucidate the techniques、efficacy and safety of transcatheter closure of large atrial septal secundum defect (ASD) with Amplatzer septal occluder(ASO).Methods Seventy-four patients of large ASD( balloon-streched diameter ≥25 mm),19 males,55 females,with a mean age of 34.9(range 8-73).After evaluation by transthoracic echocardiography(TTE), all patients underwent transesophageal echocardiography (TEE) for complete assessment of size, margins and anatomical relationship of the defect. Mean pulmonary artery pressure was (31.0±8.5) mm Hg and mean pulmonary systemic blood flow ratio(QP/QS) 1.8±0.3 through cardiac catheterization. Each case was treated with Amplatzer occluder device through the percutaneous procedure under fluoroscopy with TTE or TEE. Specific technical modifications of device placement for some large ASDs with rim deficiency were applied.Results The mean balloon-stretched defect diameter of the ASDs was 28.7±2.9 mm (range 26-38 mm). Device deployment was successful in 72 cases with successful rate of 97%. Mean fluoroscopy time was 14 minutes (range 4-56 min) . After ASD closure, the mean pulmonary artery pressure was reduced to (19.0±6.7) mm Hg, a trivial leak was present in 5 patients(≤4 mm) by echo. In one case ,two hours following successful device closure, pericardial effusion occurred but remained stable after pericardial drainage. Other 7 cases experienced arrhythmia problem. Two procedural failures included one device embolization and failure to deploy in the other; due to absence of posterior rims. The device position was stabilized in all successful cases after follow-up for 1 month to 3.4 years; with only one residual flow.Conclusions Trans-catheter closure of large ASDs with ASO is feasible and effective, but can not get rid of any procedural risk and complication, further improvement is still in need.