房间隔缺损合并房间隔膨出瘤介入治疗临床研究

Intervention therapy of atrial septal defects associated with atrial septal aneurysm

目的探讨采用小腰大边型的房间隔缺损封堵器(ASO)介入治疗房间隔缺损(ASD)合并房间隔膨出瘤(ASA)的安全性及有效性。方法选取2008年7月至2017年3月沈阳军区总医院收治的ASD合并ASA患者78例为研究对象。本组患者术前行经胸超声(TTE)或经食道超声(TEE)检查,诊断为ASD合并ASA。其中,合并多个(2个及以上)缺损的患者45例,测量ASA基底部直径为10.0~36.0 mm,平均直径(22.2±6.2)mm;缺损直径为3.0~16.0 mm(多发缺损以较大孔直径为主),平均直径(8.6±3.1)mm。术后1、3、6个月行TTE复查,并观察患者的右心房前后径、左右径,右心室内径变化情况。结果所有患者均成功植入小腰大边型ASO,封堵器对毗邻结构均无影响。术后即刻,TTE示70例完全闭合,8例有少量残余分流但无血流动力学意义,完全闭合率89.7%(70/78);术后1个月复查TTE,有3例微量残余分流,完全闭合率96.2%(75/78);术后6个月复查TTE,有1例微量残余分流,完全闭合率98.7%(77/78)。术后3 d,1、3、6个月TTE测量右心房、右心室内径,均较术前缩小(P<0.05)。手术过程未出现心脏穿孔、封堵器脱落等不良反应。结论采用小腰大边型ASO封堵ASD合并ASA,可以避免使用多个封堵器,最大限度的遮盖缺损和ASA,明显降低术后残余分流的发生率,在临床上是一种安全、有效的治疗方法。

Objective To evaluate the safety and efficiency of transactheter closure of atrial septal defect（ASD） with atrial septal aneurysm（ASA） with domestic small waist and big edge type atrial septal occluder（ASO）.Methods A retrospective study was performed on 78 cases of patients with ASD combined with ASA from July 2008 to March 2017.All patients received transthoracic echocardiography（TTE） or transesophageal echocardiography（TEE）,including 45 cases were combined multiple（2 or more） defects in all cases,the largest diameter of basilar part of ASA was 10.0 to 36.0 mm,mean（22.2 ± 6.2） mm;the largest diameter of defect was3.0 to 16.0 mm（multiple defects were mainly in diameter of large holes）,mean（8.6 ± 3.1） mm.The TTE review was performed 1,3 and 6 months after surgery,the patients＇ right atrial（RA） diameter,left and right diameter,right ventricular（RV） endoscopy was performed.Results Transcatheter closure was successfully performed in all cases using small waist and big edge type ASO.All implanted devices had no adverse effect.There were 70 patients were closed complately by TEE after the procedure,except 8 cases occurred small residual shunt without hemodynamic significance,and the immediately complete closure rate was 89.7%（70/78）.TTE review of 1 month after surgery,3 cases have residual shunt,and the complete closure rate was 96.2%（75/78）;TTE review of6 months after surgery,1 case have residual shunt,and the complete closure rate was 98.7%（77/78）.TTE showed the diameter of RA and RV were reduced after the procedure in 3 days,1 month,3 months and 6 months（P〈0.05）.No cardiac perforation,occluder shift and other adverse complications occurred during the procedure.Conclusion The use of domestic small waist and big edge type ASO could better cover defects and significantly reduce the incidence of residual shunt,which is a safe and effective treatment in clinic.