老年房间隔缺损患者介入封堵治疗疗效分析

Therapeutic effectiveness of transcatheter closure of atrial septal defect in senile patients

目的总结老年房间隔缺损(ASD)患者介入封堵治疗临床经验和疗效,探讨其适应证和操作原则。方法选择老年ASD患者38例,经超声心动图检查测量ASD大小、类型、边缘残端条件、分流方向,确定适应证。选12～32 mmASD封堵器,在放射线导引下封堵ASD。术后1、3、6、12个月复查。结果介入封堵成功37例,占97.4%,封堵失败1例,无死亡,无心包填塞等严重并发症发生。发生残余分流1例,术后早期发生阵发性房性心动过速1例,频发房性期前收缩2例,偶发房性期前收缩6例。随访期间患者右心室内径明显减小,三尖瓣反流面积明显缩小,肺动脉收缩压、平均压明显降低,心功能明显改善(P<0.01)。结论老年ASD患者介入封堵治疗安全可靠、疗效确切,但需严格掌握适应证,同时综合治疗各种合并症。

Objective To summarize the clinical experience and therapeutic effectiveness of transcatheter closure of atrial septal defect（ASD） in senile patients,and to investigate the indications and manipulating principle of the operation. Methods Thirty-eight senile patients underwent in- terventional therapy for closing ASD with Amplatzer type oceluder. Before operation, the size, site,shape and extent of ASD and direction of shunt through ASD were identified by echocardio- graphy. The size of occluders were selected from 12 mm to 32 ram. All the patients were reexam- ined 1,3,6 and 12 months after the operation. Results Thirty-seven patients were successful in transcatheter closure,success rate was 97.4%. The mortality was zero. Residual shunt was found in I patient, paroxysmal atrial taehycardia in 1 patient,and atrial premature beats in 8 patients. There was no pericardial tamponade or other severe complication. During follow up,the right ventricular internal diameter grew downwards, tricuspid regurgitation and pulmonary hypertension reduced, and the heart function improved obviously. The results of follow up demonstrated that the therapeutic effectiveness was satisfactory. Conclusion Transcatheter closure of ASD in senile patients is a safe therapeutic method with very good efficacy, nevertheless, the operative indication should be suitable, and the complications should be treated simultaneously.