巨大房间隔缺损介入封堵治疗的可行性和安全性评价

Safety and efficacy of transcatheter closure of large atrial septal defect

目的:分析我院治疗的12例巨大房间隔缺损(ASD)患者,评估其介入治疗的疗效及安全性。方法:12例患者均为继发孔型ASD,其中男性5例,女性7例,年龄(36.3±10.6)岁,超声测量ASD缺损直径平均为(33.1±4.5)mm。4例患者心房顶部残端<3mm或边缘菲薄,3例患者主动脉部位的残端<3mm或缺如;肺动脉平均压力(36.2±13.1)mmHg,中度以上肺动脉高压7例;心脏显著扩大者6例。均应用国产封堵器,封堵器直径36～42mm。术后1周、3、6、12个月行胸片、心电图、心脏彩超随访。结果:12例患者均采用右上肺静脉释放法,10例手术成功,2例缺损直径>40mm者手术失败,手术成功率为83.3%。2例患者术后超声检查显示有少量残余分流,术后1周残余分流消失。1例心房顶部残端<3mm患者术后1d封堵器脱落,行急诊外科手术。术后3个月～6年的随访中,5例肺动脉高压患者术后3个月内肺动脉压力均显著下降,6例心脏显著扩大者心脏均明显缩小。所有患者均无房水平的分流,未发现栓塞性疾病、感染性心内膜炎、传导系统异常、偏头痛等并发症。无死亡病例。结论:介入治疗巨大房间隔缺损安全、有效,但应该注意适应证的选择和术后监测。

Objective：This study was to evaluate the safety and efficacy of transcatheter closure of large atrial septal, by analyzing the treatment of 12 cases of ASD defined as 〉30mm in diameter. Methods： Twelve patients with secondary LASD[Sex： 5 male and 8 femal; age （36.3 ± 10.6） years old; ASD diameter：（33.1 ± 4.5）ram; 4 with stump of top atrium cordis 〈3mm; 3 with stump of AO 〈3mm or absence; PAMP： （36.2 ± 13. 1）mmHg, 7 with moderate pulmonary hypertension or worse;6 with heart enlargement in X ray check. ] accepted interventional therapy with Chinese-made occluder devices （diameter： 36 - 42mm） , and were assessed with electrocardiogram （ECG）, transthoracic echocardiography （TTE） and X ray check before and after the procedure at the follow-up of 1 week,3 month,6 month and 1 year. Results：In 12 patients treated by methods of right superior pub monary vein release,LASDs were successfully closed in 10 patients（83.3%）. Immediate residual shunt was found in 2 patients and vanished in one week. Device dislocation occurred in one case with stump of top atrium cordis 〈3mm and emergency surgical intervention was conducted. No death cases. Pulmonary pressure decreased obviously after device implantation in 5 cases with moderate pulmonary hvnertension, and hearts deflated in 6 heart-enlarged cases. No split stream occurred on atrium cordis level. No other complications such as embolization, infective endocarditls, cardiac perforation,Purkinje system abnormality and migraine was observed. Conclusion：Transcatheter closure of large atrial septal defect with Chinesemade occluder device is safe and efficiency, so long as the indications and monitoring after procedure are in attention.