根据食道超声心动图测量值选择封堵器介入治疗房间隔缺损——Amplatzer封堵法改良Ⅰ

Feasibility of transcatheter closure of atrial septal defect with amplazer septal occluder selected directly guided by transesophageal echocardiography measured diameter

目的 依据经食管超声心动图 (TEE)测量值选择Amplatzer封堵器研究房间隔缺损 (ASD)介入治疗的可行性 .方法 全组 74(男 2 6 ,女 48)例 ,年龄 7～ 6 4(31.6± 16 .4)岁 .按照选择封堵器的最终依据不同 ,分为球囊测量组 :41例 ,术中用球囊充盈测量 ASD伸展径 ,根据 ASD伸展径选择封堵器 ;非球囊测量组 :33例 ,术中 TEE测量 ASD大小直接选择封堵器 .结果 两组一般情况、超声心动图测量值和封堵器直径等均无显著性差异 .球囊测量组手术时间 (78.1± 16 .8)min和透视时间 (15 .4± 6 .1) min均明显长于非球囊测量组的 (5 6 .6± 12 .5 ) min和 (10 .1± 4.3) min(P<0 .0 1) .两组技术成功率为 10 0 % ,完全闭合率无显著性差异 (P>0 .0 5 ) .球囊组食道超声所测房缺大小和球囊伸展径均与所用封堵器大小相关良好 ,其相关系数分别为 0 .96 2和 0 .973(P<0 .0 1) .结论 直接依据 TEE测量值选择 Amplatzer封堵器对部分ASD介入治疗是安全可行的 .对于房缺周缘较长、较硬者 ;及边缘为硬缘和极软缘组成 ,而剔除极软缘者 ,TEE可直接指导 Amplatzer封堵器型号的选择 .对于房缺缘较软者 。

AIM To probe into the feasibility of transcatheter closure of atrial septal defect (ASD) with Amplazer septal occluder (ASO) device directly guided by transesophageal echocardiography (TEE ) measured diameter. METHODS There were 74 patients. The mean age was (31.6±16.4) years (ranged from 7 to 64 years). The patients were divided into 2 groups (balloon group and non balloon group) according to the guide used in ASO selection. There were 41 patients whose ASDs were occluded with ASO selected based on balloon stretched diameter (BSD) in balloon group . There were 33 patients in non balloon group. TEE measured diameters were used for selection of ASO size. RESULTS There was no significant difference between the two groups in age, weight, sex ratio, ASD diameter measured by TEE, and the size of implanted ASO devices ( P >0.05). Both procedural time and fluoroscopy time in balloon group were longer significantly than those in non balloon group (78.1±16.8) min vs (56.6±12.5) min; (15.4±6.1) min vs (10.1±4.3) min, P <0.01, respectively). There were all successful implants in both groups. The rates of complete closure of ASD were not significantly different between the two groups soon after implantation, 24 hours after implantation, and in a short time follow up duration ( P >0.05). Correlation between the TEE size of ASD or BSD size and ASO size were fine ( r =0.962 and 0.973, P <0.01, respectively) in balloon group. CONCLUSION Transcatheter closure of secundum ASD occlusion with ASO selected directly based on TEE measured diameter is safe and efficient in some ASD patients. TEE can be used for guidance of closure of ASD using ASO without the measurement of BSD of ASD in the following conditions: ① ASD with solid edge; ② ASD with very soft and floppy edge attached to solid basement and only the solid basement be measured with TEE. However, BSD should be measured in ASD with soft and floppy edge.