单纯超声引导下孕妇房间隔缺损封堵术3例

Echocardiography-guided transcatheter closure of atrial septal defects for three pregnant women

目的探讨孕期单纯超声引导下房间隔缺损(atrial septal defect, ASD)封堵术的可行性, 并总结多学科管理经验。方法回顾性分析2018年1月至2021年10月广东省人民医院完成的3例孕期超声引导下继发孔型ASD封堵术病例资料, 总结围术期、围产期多学科管理经验及预后。采用描述性统计分析。结果 3例患者因孕期常规心电图异常行心脏超声检查确诊继发孔型ASD, 经动态观察, 均出现心功能损害进行性加重表现, 经多学科评估具备孕期ASD封堵术指征及条件, 遂在单纯超声引导下行ASD封堵术, 手术均成功。术后肺动脉压力均有显著降低, 均能维持良好的心功能并耐受分娩;均足月经阴道分娩, 无流产、早产、产后出血、胎儿生长受限等并发症, 产后随访心功能均良好。结论孕期单纯超声引导下ASD封堵术可行, 通过围术期、围产期多学科动态监护及治疗, 可以获得满意的母胎结局。

Objective To investigate the feasibility of echocardiography-guided transcatheter closure of atrial septal defect(ASD)during pregnancy and summarize the multidisciplinary treatment experience for such women.Methods A retrospective analysis was performed on three women receiving echocardiography-guided secondum ASD closure during pregnancy in Guangdong Provincial People's Hospital from January 2018 to October 2021.Perioperative and perinatal multidisciplinary treatment and prognosis were described.Results All three patients underwent cardiac ultrasonography due to abnormal electrocardiogram during routine prenatal examination and were diagnosed with secondum ASD.Progressive cardiac dysfunction was found during close follow-ups and all cases met the criteria for ASD closure during pregnancy after multidisciplinary evaluation.Echocardiography-guided ASD closure was successfully performed in all patients.Pulmonary arterial pressure was significantly reduced and the cardiac function was stable after the operation.All patients delivered vaginally at term without complications such as miscarriage,premature birth,postpartum hemorrhage or fetal growth restriction and had their cardiac function recovered during postpartum follow-up.Conclusions Echocardiography-guided ASD closure during pregnancy is technically feasible.Good maternal and fetal outcomes can be obtained through multidisciplinary and close monitoring and treatment during perioperative and perinatal periods.