应用Amplatzer封堵器治疗房间隔缺损疗效评价

Evaluation of treatment efficiency of transcatheter closure of secundum atrial septal defects using Amplatzer occluder device

目的 :评价经导管置入 Amplatzer封堵器治疗继发孔型房间隔缺损 ( ASD)的治疗效果。方法 :全组 67例 ,年龄 2～ 5 9( 2 9土 15 )岁 ,术前经食管超声心动图 ( TEE)检查示 ASD直径 5～ 3 4 ( 2 2土 7) mm。所有病例均在透视及TEE监视下经导管置入 Am platzer封堵器封堵 ASD。 3例有大小紧邻的两个房间隔缺损存在 ,采用较大封堵器 ,一并封堵两个缺损。术后 2 4 h,1～ 3月及 1年分别行经胸超声心动图 ( TTE)、心电图及 X线检查评价治疗效果。结果 :67例 ASD直径的球囊测量值为 7～ 3 6( 2 2土 7) m m,选择的封堵器直径为 7～ 3 8( 2 4土 10 ) m m。 67例封堵器置入后均获得成功 ,技术成功率为 10 0 % ,术中未发生任何重要并发症 ,无急诊手术病例。术后即刻 ,TEE或 TTE显示 7例 ( 10 % )存在微量至少量残余分流。术后 2 4 h TTE显示 4例 ( 6% )存在微量至少量残余分流。术后 1～ 3月TTE示仅 1例 ( 2 % )多发 ASD存在少量分流。X线检查全部显示肺血减少 ,右心房、右心室缩小。结论 :经导管置入 Amplatzer封堵器治疗 ASD是一种有效的非手术方法 ,具有操作简便、安全、技术成功率高及封堵效果好等优点 ,适合于各年龄组继发孔型

AIM:To evaluate the treatment efficiency of transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer occluder device. METHODS: There were 67 patients. The age was 29±15 years (ranged from 2 to 59 years). The defected diameter of ASD was 22±7 (ranged from 5 to 34) mm shown by transesophageal echocardiography (TEE) before interventions. Three cases had double ASD. Each case was occluded using Amplatzer occluder device through the percutaneous procedure. The closure proccdure was guided by fluoroscopy and TEE or transthoracic echocardiography (TTE). TEE and TTE were performed immediately and TTE, ECG and X ray examination were done 24 hours, 1~3 months and 1 year after the procedure to evaluate the efficiency. RESULTS:The ballon stretched diameter of the ASDs was 22±7 mm ( ranged from 7 to 36 mm ). The diameter of the occluder selected was 24±10 mm ( ranged from 7 to 38 mm ).The success rate of placement of Amplatzer occluder was 100%. No complications occurred during the procedure, and no one needed for emergency surgery. Trivial to small residual shunts were found in 7 cases(10%) immediately after the procedure, in 4 cases(6%) 24 hour after operation. No residual shunts was found in 1~3 month follow up except in 1 case (2 %) with multiple ASD. X ray reexamination showed that pulmonary blood flow and heart size were improved. CONCLUSION:Transcatheter closure of secundum ASD using Amplatzer occluder device was an efficient for nonsurgical method for patients of any group. It had a high successful rate of technique and satisfied immediate and short term results.