应用Amplatzer封堵器经皮导管堵闭房间隔缺损(ASD)疗效评价(附16例报告)

Clinical application of Amplatzer septal occluder device for transcatheter closure of secundum atrial septal defect:a report of 16 cases

目的 评价应用Amplatzer封堵器经皮导管堵闭房间隔缺损 (ASD)治疗效果。方法 全组 1 6例 ,年龄 8- 58(31± 1 6)岁 ,体重 2 3 - 67(49.1 9± 1 0 .2 1 )kg ,术前经胸超声心动图 (TTE)或经食管超声心动图 (TEE)检查示ASD直径为 1 2 - 36(1 8.64± 6 .2 8)mm。所有病例均在透视及TTE或TEE指导下经导管置入Amplatzer封堵器堵闭ASD。 1例存在大小紧邻的两个房间隔缺损 ,采用较大封堵器一并封堵两个缺损。术后 2 4小时、1月、3月及 6月分别行TTE、心电图及X线检查评价治疗效果。结果 1 6例ASD球囊测量伸展径为 1 4 - 38(2 1 .46± 6 .1 9)mm选择的封堵器直径为 1 6 - 4 0 (2 6 .1 2± 5 .83)mm。 1 6例封堵器置入均获得成功。手术成功率为 1 0 0 % ,术中未发生任何重要并发症。术后即刻TTE或TEE显示 2例存在微量至少量残余分流。术后 2 4小时行TTE检查示仅 1例合并两个房缺的患者存在残余少量左向右分流。术后 3月TTE示该例残余分流消失。 1 1例完成术后 6月随访 ,未见残余分流及再通。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 ,适合于各年龄组选择性的继发孔型ASD的介入治疗。

Objectives: To evaluate the efficiency of transcatheter closure of secumdum atrial septal defect(ASD) using Amplatzer occluder Device.Methods:Sixteen patients with ASD were treated by transcatheter closure of ASD with Amplatzer occluder device.The mean age of patients was 31.36±16.18 years(ranged from 8 to 58 years)and the mean weight was 49.19±10.21kg(ranged from 23 to 67kg).The mean diameter of ASD was 18.64±6.28mm(ranged from 12 to 36mm)shown by transthoracic or transesophageal echocardiography(TTE or TEE) before interventions.One case had double ASD.Each case was treated with Amplatzer occluder device through the percutaneous procedure under fluoroscopy,TTE and TEE.After the procedure,TTE or TEE were performed immediately to find whether there is any residual shunt remained.TTE,ECG and X-ray examination were done 24-hour,1-month,3-month and 6-month after the procedure to evaluate the efficiency.Results: The mean ballon stretched diameter of the ASD was 21.46±6.19mm(ranged from 14-38mm).The mean diameter of the occluder selected was 26.12±5.83mm(ranged from 16-40mm).The success rate of procedure was 100%.No complications occurred during the procedure.For the case with double ASD,a larger device was used for closing both of the bigger ASD and the smaller one with good results.Trace to small residual shunts were found in two cases(12.5%) immediately after the procedure.24-hour follow-up by TTE found small residual shunt.only in the case with double ASD,3-month TTE follow-up had not found residual shunt.11 patients carried out 6-month follow-up and no residual shunt and recanalization were found. Conclusions:Transcatheter closure of selective secundum ASD using Amplatzer septal occluder device is an efficient monsurgical method for patients of any age group.The operation is simple and safe with a high success rate of placement and a good occlusion effect.The long-term follow-up remains to be studied.