经皮介入治疗幼儿继发孔型房间隔缺损的临床疗效

The clinical curative effect of percutaneous interventional therapy for children with secundum atrial septal defect

目的探讨经皮介入治疗幼儿继发孔型房间隔缺损(ASD)的安全性及有效性。方法回顾性分析2014年2月—2017年12月间我院收治的40例确诊为继发孔型ASD患者(年龄≤2岁)的临床资料,其中男13例,女27例,心脏超声显示单发ASD 37例,多发ASD 3例,合并肺动脉瓣狭窄1例,动脉导管未闭1例,合并肺动脉高压6例,患儿ASD直径(10.6±2.0)mm。采用经皮介入治疗,建立轨道后,输送系统沿股静脉、下腔静脉、右心房,通过房间隔缺损送至左心房,释放封堵器。结果 40例患儿中38例成功封堵,另2例封堵器位置不满意收回,改为择期手术。选择ASD封堵器直径(12.0±2.1)mm,输送鞘7~9 F。合并动脉导管未闭的患者术中予Plug2封堵成功;合并肺动脉瓣狭窄的患者同时行肺动脉瓣球囊成形术,压差明显下降后行房间隔缺损封堵术。所有患者术后无残余分流,随访2个月~3年,未见封堵器移位及ASD再通,术后肺动脉压均降至正常,右房、右室有不同程度缩小,复查心电图无异位心律失常、无其他并发症。结论幼儿继发孔型ASD经导管介入治疗安全,可靠,并发症少,值得推广应用。术中应根据ASD大小、边缘情况选择合适封堵器以减少残余分流、瓣膜损伤等并发症的发生。

Objective To evaluate the clinical safety and efficacy of percutaneous interventional therapy in pediatricpatients with secundum atrial septal defect（ASD）.Methods Clinical data of 40 patients（age≤2 years） with secundum atrialseptal defect treated in our hospital from February 2014 to December 2017 were analyzed retrospectively.There were 13 males and 27 females in these patients.Ultrasound of heart showed that there were 37 patients with single ASD,3 patientswith multiple ASDs.One associated with pulmonary stenosis（PS）,and 1 associated with patent ductus arteriosus.There were6 patients with pulmonary hypertension,and the diameter of ASD was（10.6±2.0） mm.All patients were proved to havesecundum atrial septal defect before intervention.In the intervention,the transport system was delivered along the femoralvein,inferior vena cava and right atrium through atrial septal defect to the left atrium,and the occluder was released there.Results Of the 40 patients,38 cases were successfully implanted,and the other two patients were not satisfied with thelocation of occlusion.The diameter of the ASD occluder was（12.0±2.1） mm and the transport sheath 7-9 F.Plug2 occluderwas implanted in the patient with patent ductus arteriosus.To the patient with PS,pulmonary valve balloon angioplasty wasperformed,and then the pressure gradient reduced obviously,after that ASD occlusion was performed.The total follow upperiod was from 2 months to 3 years.No residual shunt and unsatisfactory device position were found during the follow upperiod.The pulmonary pressure reduced to normal,and the right atrium and right ventricle were smaller in a different degree.All patients had no arrhythmia and other complications.Conclusion Transcatheter closure of ASD is safe,reliable,and hasfewer complications.It is worthy of popularization and application.Appropriate occluder should be selected according to thesize and edge of ASD to reduce complications,such as residual shunt and valve injury.