经导管介入治疗继发孔型房间隔缺损的并发症及其处理

Complications and treatment of atrial septal defects undergoing transcatheter interventional occlusion

目的探讨经导管介入治疗继发孔型房间隔缺损(ASD)的并发症及其处理办法。方法回顾性分析经导管介入封堵治疗的86例继发孔型ASD患者(男性34例,女性52例)术中及术后发生的并发症,并对并发症的处理进行总结。结果手术成功率95.3%(82/86),4例未成功者中1例封堵器脱落,急诊转心外科开胸手术取出封堵器并同时行房间隔缺损修补术;1例为置入封堵器后发生Ⅲ度房室传导阻滞,故回收封堵器,并给予激素、异丙基肾上腺素及临时心脏起搏治疗,术后24h房室传导阻滞消失;1例ASD下腔静脉边缘3mm,封堵器无法固定;1例为40mm巨大ASD,选择48mm的封堵器仍有残余分流而回收封堵器,行手术治疗。术后即刻行TTE检查,2例存在少量残余分流,术中冠状动脉空气栓塞1例,急性心包填塞1例,急诊外科手术修补后治愈。1例术后2d发生脑栓塞,1例于术后1周发现右下肢水肿,血管超声提示右髂静脉炎,未治疗,随访1个月症状消失。本组无死亡病例。随访3个月时无1例残余分流。结论应用封堵器介入治疗继发孔型房间隔缺损严重并发症发生率低,是一种安全、疗效可靠的治疗方法。

Objective To study the complications and treatment of foramen secundum atrial septal defects after transcatheter interventional occlusion. Methods To retrospectively analysis the complications and the treatment of the complications in 86 patients with foramen secundum atrial septal defects. Results The rate of technical success was 95.3%（82/86）.The number of all fails was four. The occluder ablated in one of them. He was given emengency surgery. Neoplasty was done for him and his occoder was taken off at the same time. High degree atrioventricular block was seen in one of them after occlusion, his AVB disappeared after being treated with tem- porary pacemaker and drug. Two of them failed because of their factors of ASD. There were other complications in this group. Residual shunt was found in two patients by TTE just after occlusion. Coronary artery aeroembolism, cerebral embolism and pericardial tamponade happened in one patient respective. Edema of lower limbs happened in one patient because of phlebophlogosis. There was no death in this group. No residual shunt was found in this group after three months. Conclusion Transcatheter interventional occlusion of ASD with the occluder is a safe, effective and ideal method for the treatment of ASD and has a low serious incidence of complications.