经胸超声心动图引导Amplatzer封堵器经心导管封堵房间隔缺损及疗效观察

Transthoracic echocardiographic results of catheter closure of secundum atrial septal defect using Amplatzer septal occluder

目的探讨经胸超声心动图(TTE)在引导Amplatzer封堵器经心导管封堵继发孔型房间隔缺损中的作用,并评价其初步疗效。方法运用TTE选择出适于封堵术的继发孔型ASD患者36例,并配合X线指导封堵过程,选择合适型号的封堵器并观察随访疗效。结果TTE引导封堵技术成功率100%。术后封堵完全闭合率91.7%(33/36),1个月为94.4%(34/36),3个月以上为100%。TTE所测房缺的最大直径明显小于球囊伸展径(P<0.01),但二者高度相关(r=0.93),为封堵器型号的选择提供了依据。本组36例术后随访,均未发现封堵器结构断裂、移位、血栓形成等并发症发生。结论运用TTE引导Amplatzer封堵器经心导管封堵继发孔房缺是一种安全、有效的非外科手术方法,近中期疗效可靠。较之经食管超声运用范围更广,操作更简便、安全,更易掌握及推广。

Objective To detect transthoracic echocardiographic （TTE） results of catheter closure of secundum atrial septal defect （ASD） using Amplatzer septal occluder （ASO）, and estimate the effects of the operation. Methods TTE was performed in 36 patients to select those who satisfied inclusion criteria before catheter closure. All patients were continuously monitored by TTE and X-ray during the procedure. Catheter closure effectiveness, cardiac structure and hemodynamic changes were observed and analyzed after the treatment. Results Successful device implantation was accomplished in 36 （100K） patients. Complete occlusion rate assessed by TTE was 91.7% （33/36） 24-hour after the closure, 94.4 G （34/36） 1-month later, and 100K more than 3-month follow up. Maximal diameter of ASD was significantly smaller than ballon streched diameter （BSD） （P〈0.01）, while a high correlation exists between them （r=0.93）, which could help select the ASO type. At follow up, no complications such as device disruption, device migration or cardiac perforation occurred. Conclusion Under the guidance of TTE, transcatheter closure of secundum ASD using the ASO is a safe and effective treatment, which causes less impairment or complications and has a high complete closure rate. As assessment of TTE, short-term and intermediate effectiveness of closure is positive. TTE is easier and safer than transesophageal echocardiography in guiding transcatheter closure.