主动脉无缘的房间隔缺损封堵术后封堵器形态改变的研究

The morphological changes in amplatzer device following transcatheter closure of atrial septal defects without aortic rim

目的研究主动脉无缘的房间隔缺损在封堵器置入后随时间变化封堵器形状改变,以及对主动脉壁和心房的影响。方法对成功封堵的主动脉无缘的房间隔缺损患者85例,观察置入即刻、术后1、3、6个月大动脉短轴切面封堵器的形状,以及在主动脉侧、中部和后部的厚度,左、右房伞对心房和主动脉壁的关系。结果封堵器在主动脉侧、中部和后部的厚度明显下降,分别从(18.97±4.70)mm、(15.62±4.22)mm、(15.92±3.90)mm下降至(13.80±2.20)mm、(12.36±2.30)mm、(12.29±2.38)mm,差异有统计学意义(P<0.01)。在置入即刻显示,主动脉侧封堵器形状呈张开形状,环抱主动脉壁;术后6个月,主动脉侧张开形状有32%(27/85)变为闭合形状,其余仍然为张开形状。10例伞盘与心房壁和主动脉壁以关系由刚置入时的偶尔接触型,变为间断压迫型,4例右盘伞对心房壁和主动脉壁从接触型变为间断压迫型。6例左盘伞对心房壁和主动脉壁从接触型到间断压迫型。结论封堵器随着厚度变薄,在主动脉侧形状由张开形状变为紧贴形状,可能造成主动脉和心房壁的压迫。

Objective To investigate the morphological changes in amplatzer septal occluder（ASO）over time and the influences of these changes on the atrial and aortic walls after atrial septal defect（ASD）without aortic rim closure.Methods 85 patients with ASD without aortic rim were treated with ASO devices and changes in the device shape,the device thickness of aortic side,interme-diate section and posterior,and relations of the discs to the atrial and aortic walls over time were evaluated by echocardiography im-mediately and 1,3,6 months after deployment.Results The device thickness of aortic lateral,intermediate section and posterior de-creased from（18.97±4.70）mm to （13.80±2.20）mm,（15.62±4.22）mm to （12.36±2.30）mm,and （15.92±3.90）mm to （12. 29±2.38）mm;27 of 85（32%）devices with a flare shape on the aortic side developed a closed shape,and the relations of the discs to the anterior atrial and aortic walls changed from touching to intermittent compression in 10 of the 85 cases,induded 4 right disc umbrellas and 6 left disc umbreuas.Conclusion As the device becomes thinner,and changes from a flare-to-closed shape on the aor-tic side over time,the edges of ASO can start to compress the atrial and aortic walls.