新型封堵器经胸封堵房间隔缺损386例(英文)

Transthoracic closure of atrial septal defect with a new occluder device:report of 386 cases

目的:探讨新型封堵器经胸关闭房间隔缺损的有效性和安全性。方法:设计一种新型的封堵器和传送系统:封堵器由外鞘管、内鞘管、传送杆经第4肋间和右侧房壁送出,封堵房缺。通过这种经胸方式共治疗患者386例,年龄1～79(平均11.8)岁,分析临床资料。结果:房缺平均直径为20.4(4～38)mm,成功植入封堵器382例,因房间隔多发缺损植入2个封堵器22例。整个手术时间为35～62(平均44±7.4)min;术后24h经胸B超证实手术成功率为98.9%;植入术中封堵器脱落1例,因此取出封堵器改用手术方法封闭房缺;另1例患者房缺成功封闭,术后当晚发生颅内出血,经神经外科治疗成功康复。结论:对于大多数房缺患者,经胸封闭房缺是有效且安全的,其操作也较为简便。

AIM ： To investigate the effectiveness and safety of transthoracic closure of atrial septal defects （ASD） in the treatment of ASD. METHODS： A new kind of occluder device and its delivery system were designed. The occluder device was delivered by an outer sheath, an inner sheath and a delivery rod through the fourth intercostal space and right atrial wall to occlude the ASD. A total of 386 patients （mean age 11.8 years, range： 1 -79 years） were treated using this transthoracic procedure, and clinical data were analyzed. RESULTS： Mean stretched diameter of ASD was 20.4 （range： 4 -38 wan）. Occluder devices were successfully implanted in 382 patients, and 22 patients received two devices because of multiple fenestrations in the atrial septum. The entire procedure time varied from 35 to 62 （44 ± 7.4） min and the intracardiac maneuver time varied from 9 to 17 （ 12±1.9） min. Transthoracic echocardiography showed that the success rate of total occlusion was 98.9% 24 h after implantation. Device embolization during implantation occurred in one case. The device was retrieved and the ASD was closed surgically. Cerebral bleeding occurred at night in one successfully occluded ASD case and the patient was effectively treated neurosurgically. CONCLUSION： Transthoracic closure of ASD is effective and safe with surgical ease in the treatment of the majority of ASD patients.