摘要
目的 探讨应用Amplatzer双盘闭合器关闭小儿继发孔房间隔缺损 (ASD)的临床效果。方法 71例ASD患儿。男 33例 ,女 38例 ;年龄 2~ 15岁 ,平均 (7± 4)岁 ;体重 10~ 5 0kg ,平均 (2 2±11)kg。在经胸超声 (TTE)的四腔心切面和剑下切面观察ASD的位置并测量ASD直径 ,测量房间隔(IAS)直径。在X线和超声帮助下用Amplatzer测量球囊导管测量ASD最大伸展径。根据所测得的ASD伸展径选择与之相同或比ASD大 1~ 2mm腰部直径的Amplatzer闭合器堵闭 71例患儿的ASD。术后随访疗效 ,追踪残余分流率和并发症。结果 应用此法关闭 71例ASD ,全部成功。其残余分流率为 2 8%。此方法并发症较少 ,疗效较好。本组资料分析示TTE测得的ASD径与测量球囊导管测得的ASD伸展径相关性好 ,从TTE测得的ASD径推算ASD伸展径的直线回归方程式 :6 5 4+ 0 97×TTE测得的ASD径 (心尖四腔心 )。结论 经导管关闭继发孔ASD适应证为 :(1)年龄≥ 2岁 ,体重≥10kg,ASD直径≤ 30mm的单纯继发孔ASD或合并肺动脉瓣狭窄 ;(2 )IAS≥ASD伸展径 + 14mm ;(3)ASD下缘与二尖瓣距离 >5mm ,上下腔缘、后缘≥ 5mm ,前缘≥ 2mm。超声心动图对病例的选择和对经导管监视关闭ASD术有不可忽略的作用 ,TEE还能弥补TTE的不足。Amplatzer双盘闭合器关闭ASD在儿科?
Objective To evaluate the clinical effectiveness of the transcatheter closure on closing the secundum atrial septal defects (ASD) with Amplatzer device. Methods Seventy one children (33 males and 38 females) with secundum ASD were undergone the transcatheter closure of ASD by using Amplatzer device from Aug 1998 to Sep 2000 The patients′ age was from 2 to 15 years [average (7±4) years]. The body weight was from 10 to 50 kg [average (22±11) kg]. The echocardiography echo used to detect and measure the defect of patients. Monitored by the echo and X ray the balloon stretch diameter of the ASD was recorded. The size of device was selected according to the stretch diameter of ASD . All patients were followed up.Results The transcatheter closure in all cases was successful The rate of the residual shunt was 2 8% The complication was seldom The diameter of ASD measured by the trans thoracic echo (TTE) showed a better correlation with the diameter of ASD measured by the balloon stretch The stretch diameter was estimated by a formula, that is, 6 54+0 97×the diameter of ASD measured by TTE. Conclusions The suggested indicators of transcatheter closure in ASD should include: (1)The appropriate age is above 2 years old, the weight above 12 kg, the diameter of ASD<30 mm and the defect belongs to simple secundum atrial septal defect (2) The diameter of internal atrial septum (IAS) is long enough to allow device standing, and the diameter of IAS > the stretch diameter of ASD + 14 mm (3) The distance between the rim of ASD and import cardiac structures, such as mitral valve, superior and inferior vena cava, and the posterior edge should be >5mm. The echo could help to select patients and supervise the closure of ASD. The transesophageal echo (TEE) is very helpful during the procedure. Although transcatheter closure of secundum atrial septal defect with Amplatzer device has been successfully employed, these patients should be long term followed up.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2001年第6期343-345,共3页
Chinese Journal of Pediatrics