经导管介入治疗多发孔房间隔缺损疗效评价

The closure of multiple atrial septal defects:procedural and clinical outcomes

目的:探讨经导管介入治疗多发性房间隔缺损(ASD)封堵的方法,观察术后疗效及安全性。方法:2005年1月至2020年1月,应用房间隔封堵器治疗了82例多发孔型ASD,其中男性37例,女性45例(男∶女=1∶1.2);年龄2~65岁,中位年龄6岁;体质量12~90 kg,平均(24.4±11.1)kg.术前均经体检、心电图、胸X线片及超声心动检查确诊,术后行心脏超声及临床检查随访。结果:82例多发性ASD,其中58例2处缺损,12例3处缺损,12例筛孔样,其中5例合并房间隔膨出瘤。82例均封堵成功,78例应用一个封堵器成功闭合,较大ASD直径平均(11.4±4.3)mm,较小ASD直径平均(3.8±1.3)mm,缺损之间距离(4.6±2.8)mm,较大ASD选择封堵器直径(16.9±4.2)mm;4例患者应用2个封堵器闭合,2个缺损之间距离为10~20 mm。手术即刻效果,多发性ASD即刻完全堵闭率89.0%(73/82),3例患者中量左向右分流,5例患者少量左向右分流,1例微量左向右分流信号。在3个月~1年随诊过程中,4例残余分流消失,5例超声提示靠近下腔静脉处可见少量残余分流,1年完全堵闭率93.9%(77/82)。结论:多发孔型ASD通过经导管介入治疗,疗效可靠,并发症少,儿童尽量选择一个封堵器闭合多个缺损。

Objective:To explore the feasibility and short term outcomes of transcatheter device closure of multiple atrial septal defects(ASD).Methods:From January 2005 to January 2020,82 patients diagnosed as multiple ASD by transthoracic echocardiography(TTE),including 37 males and 45 females at the age of(2-65)years,were enrolled in this study.With the guidance of TTE and X-ray,all the patients received occluder devices for closure.TTE,electrocardiography and X-ray were performed to evaluate the efficacy.Short-term(3 months to 1 year)follow-up data were analyzed.Results:Of the 82 patients,58 cases were with two defects while 12 cases were with three defects and 12 multi-foramen,5 atrial septal aneurysm combined with defects.Diameter of the large defect was(11.4±4.3)mm;length of the defect interval tissue was(4.6±2.8)mm;size of the selected device was(16.9±4.2)mm.Successful occlusion was achieved in all 82 patients,4 patients received two occluders while 78 patients were implanted with one occluder.All the patients were implanted successfully and no severe complication was found during implantation or follow-up.Immediately successful closure rate of 89.0%(73/82),moderate residual leaks in 3 cases(3.7%,3/82)and small residual leak in 5 case(6.1%,5/82)and micro residual shunts were presented in 1 cases(1.2%,1/82).All the patients were followed-up for 3 months to 1 year,small residual leaks were presented in 5 cases(6.1%,5/82),at 1 year,with a successful closure rate of 93.9%(77/82).Conclusions:Transcatheter device closure of multiple ASD is feasible and effective.Try to use one occluder to close multiple atrial septal defects in children.