肺静脉释放法在单纯超声心动图引导下经皮封堵治疗房间隔缺损中的应用

Application of Pulmonary Vein Deployment Technique for Percutaneous Closure of Atrial Septal Defect Solely Under Echocardiography Guidance

目的:探讨肺静脉释放法在单纯超声心动图引导下经皮封堵治疗房间隔缺损(ASD)的安全性和有效性。方法:2012-10至2016-09期间,入选38例ASD患者由于常规释放方法无法成功放置封堵器而接受肺静脉释放法,患者平均年龄(16.0±15.6)岁,平均体重(37.2±22.9)kg,ASD平均直径(17.1±4.2)mm。术后以超声心动图检查评价治疗效果。术后1个月、3个月、6个月和12个月及此后每年在门诊随访。结果:37例患者在单纯超声心动图引导下使用肺静脉释放法成功完成经皮ASD封堵术,1例患者改为使用可调弯鞘经皮封堵成功;平均手术时间(25.2±5.1)min,ASD封堵器平均直径(22.9±5.6)mm,2例患者术后早期有微量残余分流,无外周血管损伤、肺静脉及心脏穿孔等并发症。38例患者均康复出院,平均住院时间为(2.9±0.7)天,术后平均随访(23.9±15.4)个月,且均无残余分流、心包积液、主动脉瓣反流及肺静脉狭窄等并发症。结论:应用肺静脉释放法行单纯超声心动图引导下经皮ASD封堵术安全、有效,该方法避免了放射线损伤,为超声心动图引导下常规方法释放封堵器失败的ASD患者提供了一种简便实用的治疗方法。

Objective： To investigate the safety and efficacy of pulmonary vein deployment technique for percutaneous closure of atrial septal defects（ASD） solely under echocardiography guidance. Methods： A total of 38 ASD patients received pulmonary vein deployment in our hospital from 2012-10 to 2016-09 since the conventional method could not deliver the occluder to correct place. The patients were with the mean age at（16.0±15.6） years, body weight at（37.2±22.9） kg and ASD diameter at（17.1±4.2） mm. Operative effect was assessed by echocardiography. Follow-up study was conducted at 1, 3, 6, 12 months post-operation and at each year thereafter. Results： 37 patients were successfully finished pulmonary vein deployment for percutaneous closure of ASD solely under echocardiography guidance. One patient was successfully treated by a controlled steerable sheath. The mean operative time was（25.2±5.1） min and mean diameter of ASD occluder was（22.9±5.6） mm. 2 patients had trivial residual shunt at the early post-operative stage. No peripheral vascular injury, pulmonary vein and cardiac perforation occurred. All 38 patients were recovered and discharged. The average in-hospital time was（2.9±0.7） days. The patients were followed-up for（23.9±15.4） months, without complications of residual shunt, pericardial effusion, aortic regurgitation and pulmonary vein stenosis.Conclusion： Pulmonary vein deployment technique for percutaneous closure of ASD solely under echocardiography guidance was safe and effective; it can avoid radiation damage and provided a simple and practical method for ASD patients who failed to conventional method under echocardiography guidance.