改良肺静脉释放法在小儿房间隔缺损介入封堵术中的应用

Improved technique for transcatheter closure of atrial septal defect in children

目的探讨改良控制肺静脉释放法(双盘张开顺序法)操作技术经验在常规方法无法顺利堵闭的小儿房间隔缺损(arterial septal defect,ASD)病例中提高介入操作成功率和减少并发症的作用。方法当遇到房间隔缺损较大,边缘条件不佳时,应用改良控制肺静脉放置双盘装置封堵器法堵闭儿童ASD病例182例,男70例,女112例,年龄2～14(3.8±1.6)岁,体重9～48(22±11)kg。释放封堵器时先将左心房伞在左上肺静脉轻轻伸出,在左心房伞受肺静脉血管限制未完全张开时,迅速将右房伞在右心房侧打开,使左心房伞受重力和牵拉作用自动滑入左心房张开,左、右心房伞在房间隔两侧迅速成型站稳。堵闭术后1,3,6个月和1,3,5年进行持续临床追踪及随访,用超声复查。结果采用改良方法治疗房间隔缺损成功率为98.4%(179/182),而改良前组成功率为68%(110/160)。差异有统计学意义(P<0.01);用超声复查:肺静脉最高流速术前为:(0.5±0.2)m/s,术后:(0.6±0.2)m/s(P>0.05),堵闭术前后无明显变化。所有病例术后X线胸片无肺淤血改变。结论本项技术改良能明显提高介入治疗小儿ASD操作成功率,扩展手术适应证。未发现肺静脉梗阻等并发症。

Objectives In order to explore the experience of the improvement of the interventional treatment of atrial septal defect （ASD） in children cases, the procedure was applying the technique of controlling release the devices in the pulmonary vein （controlling two disc of device opening for subsequence）. Methods When the devices were placed on the right position with diffculty easily and failure in some cases, they had larger ASD and the rimcy deficient on the interval atrial septal（IAS）. They cann＇t be occluded by routine interventional treatment. It was helpful to put the device into the left upper pulmonary vein. The right atrium （proximal）disc open before the left atrium（distal）disc naturally falling down. At the end the double discs of the device clamped and stood up at the right position on the IAS. 182 child cases were used the controlling to release the devices in the pulmonary vein （male 70 and 112 female. The patients＇age was from 2 to 14 years old （average 3.8±1.6）. The body weight was from 9 to 48 Kg （average 22±ll ）. After closure followed up regularly by echocardiography in the 1,3,6,12 month and 3,5 years. Results The successful device employment in 179 （98.4%）cases were obviously higher than the other group （68%）.The velocity of the pulmonary vein before occlusion procedure was 0.5±0.2 m/s; after procedure was 0.6±0.2 m/s,P〉0.05,it was not significant difference. All cases can be not seen pulmonary congestion by follow up. Conclusions The method of controlling to release device in the pulmonary vein have been used 5 years in the occlusion of ASD with double disc device. The improved technique increases the successful rate and the adaptation of the interventional treatment of ASD. No any other complication has been found.