超声引导经皮不同途径封堵房间隔缺损临床研究

The study of different paths transcutaneous closure atrial septal defect under echocardiography guidance

目的:总结单纯超声引导经皮封堵房间隔缺损(ASD)的安全性及有效性,对比不同途径经皮封堵ASD的临床效果。方法:选取2013年11月至2018年12月,在河南省人民医院心脏中心超声引导经皮封堵ASD 145例,经颈内静脉途径91例,经股静脉途径54例。男性68例,女性77例,中位年龄6(3.9,11)岁,中位体质量23.0(17.3,40.7)kg。结果:患者ASD大小10(7,15)mm,封堵器大小(16.5±7.3)mm。全组患者无房室传导阻滞、二次手术、心包积液、血栓栓塞、穿刺部位血肿等并发症,3例患者残余分流。经颈内静脉途径和经股静脉途径均能顺利完成ASD封堵手术。其中局麻经胸超声引导下完成ASD封堵15例,均为经股静脉途径组,经食道超声全麻封堵130例。经颈内静脉途径组中位年龄4.1(3,8)岁,中位体质量19.1(14.8,27.1)kg、平均ASD大小(9.8±4.9)mm均明显小于经股静脉组年龄11(6,24)岁,体质量37.8(22.4,55.6)kg、ASD大小(14.1±6.2)mm(P<0.001);手术时间35(25,50)min明显短于经股静脉组45(34,70)min(P=0.022)。而经颈内静脉组ICU时间4(0,10)h、呼吸机使用时间1.2(0,2.5)h明显长于经股静脉组ICU时间、呼吸机使用时间(P<0.001)。随访:分别于术后1、3、6、12个月门诊随访,复查超声及心电图。3例残余分流患者随访期间愈合,随访期间无封堵器移位、再次手术、血栓、房室传导阻滞等并发症。结论:单纯超声引导下经皮封堵ASD安全、有效。经颈内静脉途径手术时间更短,更适用于低龄患儿;经股静脉途径手术时间长,但是使用呼吸机时间及ICU时间短,更适用于大龄患者,部分可以局麻下行经胸超声引导下封堵ASD。

Objective:To summarize the safety and effectiveness of transcutaneous closure atrial septal defect(ASD)under echocardiography guidance.Compare the clinical effects of different paths of percutaneous closure of ASD.Methods:We retrospectively studied between November 2013 to December 2018 all cases of transcutaneous closure of ASD under echocardiography in our center.145 patients were included with 68 males and 77 females.Trans-jugular transcutaneous closure of ASD and femoral vein way were 91 cases and 45 cases.The median age were 6(3.9,11)years,and weight were 23.0(17.3,40.7)kg.Results:Mediansize of ASD and Mean occluder were 10(7,15)mm and(16.5±7.3)mm.There were no complications such as atrioventric-ular block,reoperation,pericardial effusion.3 patients with small residual shunt.ASD can be successfully oc-cluded through both the jugular vein and the femoral vein path.In the femoral vein group,15 cases were occlu-ded under the guidance of transthoracic ultrasound with topical anesthesia.The median age 4.1(3,8)years,weight 19.16(14.8,27.1)kg,Mean ASD size(9.8±4.9)mm in the transjugular group were significantly lower than those in the trans femoral group age 11.6(6,24),weight 37.86(22.4,55.6)kg,ASD size(14.1±6.2)mm(P<0.001);the operation time 35(25,50)min was significantly shorter than that in the trans femoral group 45(34,70)min(P=0.022).The time of ICU 4(0,10)h,ventilator time1.2(0,2.5)h in the jugular vein group were significantly longer than in the femoral vein group,ventilator use(P<0.001).Fol-low-up was organized for all patients with clinical,ECG and echocardiographic 1 month,3 months,6 months,and 12 months after the procedure.3 patients with residual shunt were self-closed followed up for 3 months.No complications(e.g.,reoperation,atrioventricular block,occluder abscission,thromboembolism)were observed.Conclusions:Transcutaneous closure ASD under echocardiography is safe,effective.The operation time via the jugular vein is shorter,which is more suitable for the young children.The time of ventilator and ICU is shorter in the trans femoral group,which is more suitable for the old patients,some of them can be oc-cluded ASD under the guidance of transthoracic ultrasound under local anesthesia.