应用Amplatzer封堵器治疗先天性心脏病

Transcatheter treatment of congenital heart diseases using the Amplatzer occluder

目的 :探讨Amplatzer封堵器在治疗先天性心脏病中的效果、安全性及并发症等情况。方法 :18例动脉导管未闭 (PDA)患者和 10例房间隔缺损 (ASD)患者行Amplatzer封堵器治疗。PDA封堵器置入到位后即刻行胸主动脉造影 ,以明确封堵器的位置情况及有无残余分流。测量升主动脉和降主动脉压力以及左肺动脉和肺动脉干压力变化情况。在超声和X线引导下 ,经导管将封堵器送到房间隔缺损处释放 ,使封堵器腰部卡于ASD处 ,两伞贴于房间隔两侧。术后分别于 1周、1个月、3个月、6个月复查胸部X线平片和心脏彩超检查 ,以明确有无残余分流和再通发生。结果 :2 8例患者均成功地置入了该封堵器 ,且未发生溶血、封堵器移位、血栓形成、残余分流和再通等并发症。整个手术操作时间为 2 5～ 13 0min ,平均约 5 8min ,操作中累计透视时间约 8～ 18min ,平均约 11.5min。术后当天、1周、1个月复查胸部X线平片和心脏彩超 ,均未见残余分流及封堵器脱落、移位、再通等改变。 15例随访观察 3个月以上未见明确的并发症发生。结论

Objective:To evaluate the efficiency,safety and complications of transcatheter closure of congenital heart diseases using the Amplatzer occluder.Methods:Of the 28 patients,there were 18 cases of patent ductus arteriosus(PDA) and 10 cases of secundum atrial septal defects(ASD).All of the patients underwent transcatheter closure using the Amplazter occluder followed by the lateral descending aortography to demonstrate the site of the Amplatzer occluder and whether the shunt remained or not.The pressure of ascending and descending aorta, left pulmonary artery and pulmonary trunk was measured. The implantation of the device was accomplished under US and X ray guidance. In all patients, X ray and echocardiography were performed 1 week,3 months and 6 months later,in order to find whether there were residual shunt and recanalization.Results:The device was successfully implanted in all patients.No severe complications such as hemolysis, device thrombosis,residual shunt and recanalization were observed.The median operation time was 58 minutes(range of 25～130 minutes),and median fluoroscopy time 11.5 minutes(range of 8～18 minutes).The positions of occluder were optimal while no residual shunt,no recanalization and no migration of the device were found by X ray and echocardiography 24 hours,a week and a month later after the procedure.No complications were observed during the 3 month follow up in 15 patients.Conclusion:The Amplatzer occluder is a safe and effective device for catheter closure of the PDA and ASD.