儿童房间隔缺损介入治疗后并发症的随访研究

Follow up of the children with complications after percutaneous closure of atrial septal defect.

目的随访观察儿童继发孔型房间隔缺损（ASD）介入治疗后并发症的发生及转归情况。方法192例介入治疗成功且随访时间超过1个月的ASD患儿，ASD直径8．0—33．0mm，平均（16．7±8．0）mm。128例应用Amplatzer房间隔封堵器，64例应用国产房间隔缺损封堵器，封堵器大小8．0～38．0mm，平均（18．9±8．2）mm。随访时间1个月-4年，平均（19．0±4．5）个月。术前及术后24h和术后1、3、6、12个月及以后每1～2年行超声心动图及心电图（EC6）检查。结果①并发症总的发生率为3．6％（7／192），其中残余分流占1．6％（3／192），窦性心动过缓占0．5％（1／192），I度房室传导阻滞占0．5％（1／192），封堵器微移位并残余分流占0．5％（1／192），斑秃占0．5％（1／192）。②ASD的大小和缺损的多少与并发症的发生情况：单孔型ASD共184例，并发症的发生率为2．7％（5／184），其中ASD≤10mm5例均无并发症发生，ASD10-20mm者并发症的发生率为1．7％（2／119），ASD≥20min者并发症的发生率为5．0％（3／60）；两孔和多孔型ASD共8例，并发症的发生率为25．00k（2／8）。③并发症出现的时间：术后24h内并发症的发生率为3．1％（6／192），分别为残余分流3例、Ⅰ度房室传导阻滞1例、窦性心动过缓1例、封堵器微移位并残余分流1例；术后2d-2周发生斑秃1例（0．5%，1／192）。④并发症的处理情况：残余分流、封堵器微移位和斑秃患儿均未予特殊处理，窦性心动过缓者给予地塞米松和阿托品治疗，房室传导阻滞者给予地塞米松治疗。⑤并发症的转归情况：完全恢复4例（57．1％），分别为残余分流、Ⅰ度房室传导阻滞、窦性心动过缓和斑秃各1例；少量残余分流2例和封堵器微移位1例未恢复。结论继发孔型房间隔缺损介入治疗后总的并发症少，大部分并发症在随访过程中可完全恢复，一些少见并发症仍需长期随访观察。

Objective To observe the complications in children after percutaneous closure of atrial septal defect （ASD）. Methods 192 children,who successfully received percutaneous closure of ASD in our hospital were enrolled in this study. Diameter of ASD was 8.0 - 33.0 （ 16.7 ± 8.0 ） mm, the diameter of occluder was 8.0 - 38.0 （ 18.9 ± 8.2） mm. The follow-up term ranges from 1 month to 4 years, with a mean of 19.0 ± 4.5 months. Standard 12-lead electrocardiography （ECG.） and transtharacic echocardiography （TIE） were performed before closure,24 hours, 1,3,6,12 months and yearly after closure. Results （1）The incidence of complications was 3.6% （7/192）, including： minimal-moderate residual shunt in 3 patients （ 1.6% ）, atrial-ventricle block （ AVB ） in 1 （0.5%）, sinus bradycardia in 1 （0.5%） ,and device micro-malposition in 1 patient（0.5% ） ,while pelade in 1 patient（0.5% ）. （2） There were 184 cases of single-hole ASD, with complication rate of 2.7% （5/184）, including the complication rate in diameter of single-hole ASD less than 10mm was 0%, that in ASD between 10 mm and 20 mm was 1.7% （2/119） ,that in ASD more than 20 mm was 5.0% （3/60） ,while there were 8 cases of twoand multi-hole ASD, with complication rate of 25.0% （2/8）. （3）There was 6 cases （3.1% ） with complications within 24 hours after occlusion, including 3 cases of minimal-moderate residual shunt, 1 case of atrial-ventricle block, 1 case of sinus bradycardia, and 1 case of device-micro-malplosition. 2 days to 2 weeks after procedure, 1 case developed pelade （1/192）. （4）Residual shunt, micro-malpositian and pelade were not managed, while sinus bradycardia was treated with dexamethasone and atropine, and atrial-ventricle block was treated with dexamethasone. （5） Among them, 4 cases were completely recovered （57. 1% ）, including 1 case of residul shunt, 1 case of atrial-ventricle block, sinus bradycardia and 1 case of pelade. 2 cases of minimal residual and 1 case of device-micro-malposition were not recovered. Conclusions Transcatheter closure of ASD is safe and effective with few complications, most of which disappcare completely during follow up term. Long-term follow-up is needed to evaluate the progress of some rare complications.