多发性房间隔缺损经导管封堵治疗中封堵器的个体化运用

Individualized application of occluder in transcatheter closure of multi-fenestrated atrial septal defects

目的评估多发性房间隔缺损(mfASD)经导管封堵治疗中个体化选择封堵器对疗效和并发症的影响。方法回顾性入选2006年7月至2015年7月在复旦大学附属中山医院心内科住院的mfASD患者共76例,收集患者临床及随访数据。结果 76例患者中男性18例,年龄18~75(42.3±14.9)岁。房间隔缺损(ASD)形态学特点为:60例(78.9%)为双孔性ASD;16例(21.1%)为筛孔性ASD,其中有3例(3.9%)为卵圆孔未闭(PFO)合并ASD,13例(17.1%)合并房间隔瘤。73例(96.1%)患者器械封堵成功,其中26例(35.6%)使用双封堵器封堵成功(双封堵器组),47例(64.4%)使用单封堵器封堵成功(单封堵器组)。在单封堵器组中,有7例(14.9%)患者使用测量球囊辅助后封堵成功。单封堵器组使用大小边型封堵器比率高于双封堵器组[11例(23.4%)比3例(11.5%),P=0.352],但差异无统计学意义;单封堵器组患者并发症发生率显著低于双封堵器组(4.3%比19.2%,P=0.037),差异有统计学意义。随访发现两组患者残余分流发生率的差异无统计学意义(P>0.05)。结论经导管封堵治疗mfASD应根据ASD的形态学个体化选择封堵器,对于特定的患者使用双封堵器治疗mfASD是可行、安全和有效的。

Objective To evaluate the impact of individualized occluder application on efficacy and complications of transcatheter closure treatment for multi-feneatrated atrial septal defects （mfASD）.Methods Seventy six patients with mfASD who were hospitalized at Fudan University Zhongshan Hospital from July 2006 to July 2015 were retrospectively enrolled.Clinical and follow-up data were collected and analyzed.Results Among the 76 patients including 18 males and 58 females,transcatheter closure was successfully performed in 73 patients （96.1%）.The morphological features of ASD included： 60 cases （78.9%） with two defects and 16 cases （21.1%） with cribriform defects, 3 cases （3.9%） combined with patent foramen ovale （PFO）,13 cases （17.1%） with atrial septal aneurysm （ASA）.Dual occluders were used for closure in 26 patients （35.6%）,while single occluder was implanted in 47 patients （64.4%）.In single-occluder group,measuring balloon was used to assist occlusion in 7 patients （14.9%）.3 patients versus 11 patients required the small-waist-big-edge occluders in the dual-occluder group and the single-occluder group respectively （11.5% vs.23.4%, P=0.352）.The complication rate in the dual-occluders group was higher than that in the single-occluder group （19.2% vs.4.3%, P=0.037）,while the incidence of residual shunt showed no significant difference between these two groups （11.5% vs.10.6%, P=0.906）.Conclusions The occluder for transcatheter closure of multiple atrial septal defects needs to be individually chosen according to the morphological characters.Transcatheter closure of mfASD using two devices is feasible,safe and effective for selected patients.