经胸超声心动图监视下应用Amplatzer封堵器治疗房间隔缺损

Transcatheter closure of secundum atrial septal defects using Amplatzer occluder device with transthoracic echocardiography

目的 :评价在经胸超声心动图 (TTE)指导下置入 Am platzer封堵器治疗继发孔型房间隔缺损 (ASD)的可行性和治疗效果。方法 :全组 5 0例 ,年龄 1～ 5 1(18.8土 14.6 )岁 ,术前经 TTE检查示 ASD直径平均为 4～ 33(18.3土 6 .0 ) mm。所有病例均在透视及 TTE监视下经导管置入 Amplatzer封堵器封堵 ASD。术后 3d,1～ 3月分别行经胸超声心动图、心电图及 X线检查评价治疗效果。结果 :5 0例 ASD直径的球囊测量值为 5～ 35 (19.1土 6 .9)mm,选择的封堵器直径为 5～ 36 (2 0 .9土 7.0 ) m m。 5 0例封堵器置入均获得成功 ,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 TTE显示 4例 (8.0 % )存在微量至少量残余分流。术后 3天 TTE显示 2例 (4.0 % )存在微量残余分流。术后 1～ 3月 TTE显示 5 0例 ASD完全闭合。X线检查全部显示肺血减少、右心房、室缩小。结论 :经胸超声心动图指导下经导管置入 Am platzer封堵器治疗 ASD是一种有效、安全、可行的非外科手术方法。我们建议 30 m m以上的 ASD应在经食道超声心动图下监视封堵。

AIM: To evaluate the treatment efficiency and the feasibility of transcather closure of secundum atrial septal defect (ASD) using Amplatzer occluder device by transthoracic echocardiography(TTE). METHODS: There were 50 patients. The mean age was 18.8±14.6 years (ranged from 1 to 51 years). The mean diameter of ASD was 18.3±6.0 mm (ranged from 4 to 33) shown by TTE before interventions. Each case was occluded using Amplatzer occluder device through the percutaneous procedure. The closure proccdure was guided by fluoroscopy and TTE. TTE was performed immediately and TTE, ECG and X-ray examination were done 3 days and 1~3 months after the procedure to evaluate the efficiency. RESULTS:The mean ballon stretched diameter of the ASDs was 19.1±6.9 mm ( ranged from 5~35 mm ). The mean diameter of the occluder selected was 20.9± 7.0 mm ( ranged from 5~36 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 4 cases(8.0%) immediately after the procedure, in 2 cases( 4.0%) 3 days. No residual shunts was found in 1~3 month follow-up. X-ray examination showed that pulmonary vascularity and heart size were improved. CONCLUSION: Transcatheter closure of secundum ASD using Amplatzer occluder device with TTE guidance was an efficient, feasible and safe nonsurgical method. It had a high successful rate of technique and satisfied immediate and short term results.We suggest that the more than 30mm ASD ahould be closured by monitoring of transesophagus echocardiography.