Amplatzer封堵器经导管治疗多孔房间隔缺损

Transcatheter closure of multiple secundum atrial septal defects using Amplatzer septal occluder

目的 :探讨 Amplatzer封堵器经导管治疗多孔房间隔缺损的临床应用价值。方法 :全组患者 6(男 2 ,女 4)例 ,年龄 4～ 5 0岁 ,经 TTE或 TEE检查诊断为多孔房间隔缺损。均在 X线和 TTE或 TEE监测下经导管行 Amplatzer封堵器治疗。术后重复 TTE或 TEE、ECG及 X线平片检查以评价疗效。结果 :全组 6例患者 Amplatzer封堵器置入均获成功 ,术中无重要并发症发生。其中置入 1个封堵器的患者 5例 ,置入 2个封堵器的患者 1例。术后即刻TTE或 TEE检查 5例无残余分流 ,1例小缺损孔有少量残余分流 ,随访 1年中少量残余分流仍存在。1例肺动脉压中度增高患者 ,术后 3 0 min测量肺动脉压下降 >2 0 mm Hg。随访期间所有患者封堵器位置形态良好 ,未发现封堵器的变形 ,移位以及金属结构断裂等改变 ;右房 ,右室有不同程度的缩小 ,X线平片显示肺血有不同程度减少 ;术后ECG检查均未见心律失常发生。结论 :Amplatzer封堵器经导管治疗多孔房间隔缺损是安全有效的。对于相隔距离较近的多孔房间隔缺损 ,可采用单个封堵器封堵 ;而相隔距离较远的缺损 。

AIM: To investigate the effectiveness and safety of transcatheter closure of multiple secundum atrial septal defect (ASD) using Amplatzer septal occluder. METHODS: 6 Patients (2 mals, and 4 females) diagnosed of multiple ASDs by TTE or TEE were investigated. The age rangs from 4 to 50 years. All the patients received transcatheter closure of ASD guided by X ray fluoroscopy and echocardiography by using Amplatzer septal occluder. TTE or TEE, ECG, X ray examinations were repeated after the procedures as follow ups to evaluate the safety and efficiency. RESULTS: The placement of the occluders were successful in all the 6 patients. There was no serious complication during the procedure. 1 occluder was implanted in each of 5 patients, and 2 occluders were implanted in the other 1 patient. 5 of the patients showed no residual shunt immediately after the procedure examined by TTE or TEE, While one patient implanted with one occluder showed trial or small residual shunt of small defect. Trial or small residual shunt of small defect also existed in one year's follow up. One patient with pulmonary hypertension, pulmonary pressure decreased above 20 mm Hg 30 min after the procedure. The shape and the position of all the occluders were good during the follow up. No displacement and malformation of the occluders were found. Heart size and pulmonary vascularity were improved in all the patients during the follow up. No arrhythmia occurred during the follow up. CONCLUSION: Transcatheter closure of multiple secundum ASD using Amplatzer septal occluder is safe and effective. One occluder can be used in the multiple ASD with short distance between the defects, and 2 occluders can be used with long distance.