超声导引下介入治疗继发孔型房间隔缺损及合并畸形428例临床报告

Intervention treatment of secundum ASD complicated with other malformations under echocardiographic guidance in 428 patients

目的:报告我院1998年10月～2004年10月超声导引下介入治疗ASD合并畸形428例,主要讨论介入适应证,操作原则及临床效果。方法:住院患者继发孔型ASD428例,男150例,女278例(男∶女=1∶1.9),年龄2～74岁(平均26.6±16.6)。428例ASD为中央型,其中单一ASD416例,多发型ASD12例,合并畸形70例,其中合并肺动脉瓣狭窄(PS)14例,肺动脉高压(PH)11例,二尖瓣狭窄(MS)(芦停巴赫综合征)3例,合并室上速3例,合并心房纤颤14例,其它25例。使用日本东芝6000型和美国惠普1500型彩色多普勒血流显像仪和食道超声(TEE)探头频率分别为2.5MHz和5MHz。术前用TTE诊断,术中用TEE配合,儿童<10岁用TTE配合。结果:介入术中超声导引导入球囊导管测量最大ASD伸展直径,用TTE或TEE测量ASD直径及确定ASD位置、大小及数目。428例ASD患者成功介入425例,介入技术成功率99.3%。介入手术并发症总发生率2.1%。合并畸形的治疗,超声导引介入治疗合并畸形,待合并畸形治愈后方再行ASD介入治疗,本组合并畸形介入治疗成功率100%。结论:ASD及合并畸形的介入治疗,必须要在超声导引和监测下主要掌握ASD及合并畸形疾病的适应证,操作规范化,成功率很高,而且是安全有效的。

Objective： To evaluate indications, technical procedure and clinical efficacy of interventional treatment of secundum ASD complicated with other malformations under echocardiographic guidance. Methods： From October 1998 to October 2004, 428 patients with secundum ASD, 150 males, 278 females, at a mean age of （26.6±16.6） years（ranged from 2 to 30 years old） with a mean weight of （51.1±18.2）kg（ranged from 11 to 110kg） were studied. All ASD were central, including single-fenestrated ASD（n=416） and multi-fenestrated ASD（n=12）. In addition to ASD, 70 patients accompanied with other malformations. These abnormities included pulmonary stenosis （n=14）, pulmonary hypertension （n=11）, mitral valve stenosis （n=3）, supraventricular tachycardia（n=3）, atrial fibrilation（n=14）. Detecting frequencies of ultrasound instruments（CDFI, Toshiba 6000, Japan, and HP 1500, America） were 2.5MHz and 5.0MHz respectively. Diagnosis was determined with transthoracic echocardiography before the interventional procedure, which was performed under the support of transesophageal echocardiography in adult and transthoracic echocardiography in children less than 10 years old. Results： The maximum diameter of ASD was measured by the expanding balloon diameter under echocardiographic guidance, position and number was decided by transesophageal echocardiography or transthoracic echocardiography. Devices were successfully implanted into 425（99.3%） of the 428 patients. In addition to ASD occluder implantation, some patients underwent interventions of complicated malformations during the same catheterization. ASD closure procedure started under echocardiographic guidance till complicated malformations were cured. One or several devices were selected for closure of muhi-fenestrated ASD based on defect diameter and distance measured by transesophageal echocardiography. In this group, all the malformations were successfully cured. Conclusion： Interventional treatment of ASD complicated with other abnormities under echocardiographic guidance is safe and effective.