高原地区老年房间隔缺损介入封堵治疗疗效和安全性研究

Efficacy and Safety of Transcatheter Closure of Atrial Septal Defect in Senile Patients at High Altitude

目的：探讨高原地区经导管介入封堵治疗老年房间隔缺损（ASD）的有效性和安全性。方法：分析经导管封堵治疗的37例老年ASD患者的临床和介入治疗资料。结果：全组治疗成功率为90.1%,TTE测量ASD平均大小（24.7±6.1）mm,封堵器平均大小（28.2±8.6）mm,均采用国产封堵器。术后3个月平均肺动脉收缩压较术前下降明显（38.5±15.4）mmHg vs（57.2±14.8）mmHg,P〈0.05,右心房、右心室内径较术前减小。微少量残余分流3例,3个月后复查分流消失。并发症发生率10.8%,无死亡病例。随访（6-42）个月,封堵器无移位,心功能改善。结论：高原地区老年ASD患者有缺损大、肺动脉高压程度严重、合并症多的特点,严格掌握适应证,规范操作,积极治疗合并症,是成功封堵的关键。

Objective： To evaluate the efficacy and safety of transcatheter closure of secundum atrial septal defect（ ASD） in senile patients at high altitude. Methods： Clinical and right catheterization information of 37 patients over 60 years underwent transcatheter closure of ASD were retrospectively analyzed. Results： The overall successful rate was 90. 1%,these cases were all treated by home- made occluder. The ASD size was（ 24. 7 ± 6. 1） mm by transthoracic echocardiography（ TTE）,and the size of device was（ 28. 2 ± 8. 6） mm,The mean pulmonary arterial systolic pressure,right atrial diameter and right ventricular diameter were decreased significantly at three months after operation. There was three residual shunts and disappeared at six months follow-up. The complicated rate was10. 8%,however there was no death. After 6 to 42 months follow up,there were no migration or fracture of occluder.Conclusions： Transcatheter closure of secundum ASD is an efficient and safe method for senile patients,but the operative indication must be closely suitable for cases,and procedure must conform to the standard.