经胸非体外循环下房缺微创封堵术的疗效评价

Evaluation of minimally invasive device closure of isolated congeital atrial septal defect(ASD) via thoracic cavity without CPB

目的评价经胸非体外循环下房缺微创封堵术的疗效。方法 15例患者,男7例,女8例,平均年龄5.5岁,平均体重20.8 kg。经胸心脏超声显示Ⅱ度孔房间隔缺损,均为中央型。缺损直径8～26 mm,平均14.5 mm。气管插管全身麻醉后,经胸骨旁右第四肋间切口,长2～3 cm。在食道超声的引导下,经右房壁置入腰部直径12～32 mm的国产房缺封堵器。结果 15例患者均成功封堵,无中转体外循环病例。2例患者术后新发右束支传导阻滞。无Ⅲ度房室传导阻滞发生。患者术后住院时间3～8 d,平均4.6 d。随诊3～6个月,1例术后大量胸腔积液,经胸腔闭式引流后痊愈。余患者均恢复良好,无Ⅲ度房室传导阻滞,无残余分流,无封堵器晚期移位,无瓣膜关闭不全加重。结论经胸非体外循环下房缺微创封堵术创伤小、安全性高,近期疗效满意。远期疗效仍须进一步观察。

Objective To evaluate the effect of minimally invasive device closure of isolated congeital atrial septal defect（ASD） via thoracic cavity without CPB. Methods Fifteen patients（7 male,8 female;median age 5.5 years;median body weight 20. 8 kg） underwent TTE, all were found with ASD of central type. The diameter of ASD ranged from 8mm to 26 mm （median 14. 5 mm）. Under general anesthesia with trachia intubation, the chest was opened through an 4th right intercostal space incision near sternum of 2 to 3 cm long. Guided by TEE,home -made occluders of 12 -32 mm in waist diameter were implanted through free wall of right atrium. Results All of 15 patients were occluded successfully. None of them repuired CPB. Two patients showed acquired right bundle branch block after operation. No Ⅲ° A - V block happened. The hospitality time was 3 to 8 days, median 4.6 days. Daring a followup of 3 - 6 months,one had a thoracic effusion of large quantity, but cured following thoracic drainage. Other patients recovered smoothlly. No Ⅲ° A - V block, residual shunt,later phase occluder move and aggravating mitral or tricuspid incompetence happened. Conclusion Minimally invasive device closure of isolated congeital atrial septal defect（ASD） via thoracic cavity without CPB was mini -invasive, safe and short- term effective. The long - term effect still need to be evaluated.