合并非经典适应证的多发性房间隔缺损介入治疗

Interventional treatment of multiple atrial septal defect with non-classical indications

目的探讨合并下腔型或边缘极短等非经典适应证之多孔型房间隔缺损(ASD)进行介入治疗的可行性。方法选择合并2014年9月至2019年9月间中国医学科学院阜外医院上述非经典适应证的多孔型ASD术前先行多排螺旋计算机断层扫描(MDCT)检查及3D模型打印,对其中缺损大小合适者10例行介入治疗并收集其临床及随访数据。组间比较采用配对t检验。结果 10例患者介入治疗均获得成功,其中9例植入动脉导管未闭(PDA)和ASD封堵器各1枚,1例植入2枚ASD和1枚PDA封堵器。10枚PDA封堵器型号为(16/14~32/30) mm,平均为(23.80±5.85)/(21.80±5.85) mm;11枚ASD封堵器型号为(10~36) mm,平均(23.27±7.91) mm。术后均未出现明显并发症。术后随访的X线心胸比(0.44±0.02)较术前(0.50±0.03)明显降低(t=5.670,P<0.05)。经胸超声心动图(TTE)右室前后径[(26.60±3.69) mm]较术前[(33.20±6.00) mm]明显降低(t=5.250,P<0.05),差异有统计学意义。结论采用PDA封堵器和ASD封堵器封堵非经典适应证的特殊类型多孔型房间隔缺损安全有效。

Objective To explore the feasibility of interventional treatment for multiple atrial septal defect(ASD)with non-classical indications such as inferior sinus venosus multiple ASD or extremely short rim special types of multiple ASD.Methods The above-mentioned special types of multiple ASD were subjected to multidetector computed tomography(MDCT)examination and 3D model printing performed before operation.Ten patients with appropriate defect size were treated with interventional therapy,and clinical and follow-up data were collected.Results The interventional treatment was done successfully in all 10 patients.One patent ductus arteriosus(PDA)occluder and one ASD occluder were implanted in 9 patients,and 2 ASD occluders and 1 PDA occluder were implanted in one patient.The size of 10 PDA occluders is(16/14-32/30)mm and the average is(23.80±5.85)/(21.80±5.85)mm;the size of 11 ASD occluders is(10-36)mm and average is(23.27±7.91)mm.There were no obvious complications occurred.Compared with the preoperative(0.50±0.03),the X-ray cardiotho racic ratio of postoperative(0.44±0.02)was significantly decreased(t=5.670,P<0.05).The anterior-posterior diameter of transthoracic echocardiography(TTE)[(26.60±3.69)mm]was significantly lower than that before surgery[(33.20±6.00)mm,t=5.250,P<0.05].Conclusion It is safe and effective to use PDA occluder and ASD occluder to close the special types of multiple ASD with non-classical indications.