11例先天性心脏病封堵术后残余漏的介入治疗

Transcatheter closure of residual shunt after intervention procedure of congenital heart diseases using spring coils and modified Amplatzer device

目的评价先天性心脏病(动脉导管未闭,patent ductus arteriosus,PDA;房间隔缺损,atrial septum defects,ASD)封堵后残余漏再次介入治疗的临床疗效。方法 2002年8月至2012年3月,9例PDA介入手术后残余漏患者,2例ASD介入手术后残余漏患者,术后随访发现封堵器械的分流,11例患者再次行介入治疗。术后即刻及长期应用超声心动图及实验室检查随访。结果 9例PDA及2例ASD患者中,8例再次置入蘑菇封堵器,3例弹簧圈,术后复查超声6例无残余分流;5例术后即刻存在少量残余分流,3例在术后1个月随访时残余分流消失,2例PDA患者置入弹簧圈后短期溶血,1例经内科治疗后好转,1例行外科急诊手术。结论先天性心脏病PDA、ASD介入治疗后出现残余漏行介入封堵的处理方法是可行、有效的。

Objective To evaluate the clinical efficacy of transcatheter closure of residual shunt after intervention procedure of congenital heart diseases （patent ductus arteriosus, PDA/atrial septum defects, ASD） using spring coils and modified Amplatzer device. Methods 11 patients treated with percutaneous catheter closure were involved in present study from Aug, 2002 to Mar, 2012. After the first operation, residual shunt crossing the occluders were detected by echocardiography. All patients underwent interventional occlusion the second time successfully. All patients were followed up by echocardiography and laboratory examination. Results Residual shunt was occluded by domestic occluders or spring coils in 11 patients and the procedure was successful. 6 cases had complete closure at discharge. 5 cases had residual shunt. The residual shunt disappeared gradually in 3 cases in the month after the procedure. Self-abating haemolysis happened in other 2 cases with PDA （ occluded by springeoils the second time ） 1 case was transferred to cardiac surgery and 1 case showed symptoms improved quickly after medical treatment. Conclusions Transcatheter closure with occluder is a safe and effective therapy for residual shunt after transcatheter closure of PDA and ASD.