单纯经胸超声心动图引导经皮介入治疗复杂房间隔缺损的临床疗效

Clinical Efficacy of Percutaneous Interventional Treatment of Complex Atrial Septal Defect Under Transthoracic Echocardiography Guidance Solely

目的:评价单纯经胸超声心动图(TTE)引导经皮介入治疗复杂房间隔缺损的临床疗效。方法:选取中国医学科学院阜外医院2019年1月至2019年12月在单纯TTE引导下接受经皮介入封堵复杂房间隔缺损的47例患者(男性9例、女性38例)的临床资料。所有患者术前均经超声心动图明确诊断,术中在TTE引导下经股静脉完成治疗。收集患者术前、术后6个月和12个月的超声心动图和心电图数据。结果:所有患者均使用1个封堵器完成介入封堵,平均手术时间为(55.2±21.0)min,平均住院时间为(5.0±1.7)d,封堵器的平均直径为(22.0±6.6)mm。出院前1例(2.1%)患者房水平分流7 mm(使用8 mm带孔封堵器),中量、少量、微量残余分流患者分别有4例(8.5%)、2例(4.3%)、1例(2.1%)。术后新发不完全性右束支阻滞1例(2.1%),经药物治疗后好转。与术前相比,术后6个月和12个月时患者的右心房内径、右心室舒张末期内径均明显减小(P均<0.05)。术后1年时,出院前的3例少量和微量残余分流均消失,4例中量残余分流变为少量残余分流,1例患者房水平分流由出院前的7 mm减少为5 mm;1年完全封堵率为89.4%(42/47)。结论:单纯TTE引导经皮介入封堵复杂房间隔缺损的效果良好,该方法不仅避免了放射线损伤,而且保持了传统经皮介入治疗安全、微创的优点。

Objectives:To evaluate the clinical efficacy of transthoracic echocardiography(TTE)-guided percutaneous complex atrial septal defect(ASD)interventional closure.Methods:The clinical data of 47 patients(9 males,38 females)with complex ASD,who underwent percutaneous intervention closure from January 2019 to December 2019 in Fuwai Hospital of the Chinese Academy of Medical Sciences,were analyzed.All patients were diagnosed preoperatively by echocardiography,and underwent interventional therapy guided by TTE solely.The examination results of echocardiography and electrocardiogram were collected at preoperation,at 6-month and 12-month post operation.Results:One occluder was used to complete the interventional occlusion in all the enrolled patients,the average operation time was(55.2±21.0)minutes,the average length of hospital stay was(5.0±1.7)days,and the average diameter of the occluder was(22.0±6.6)mm.Before discharge,an atrial level shunt of 7 mm width was found in a patient(2.1%)occluded by an 8 mm perforated occluder;moderate residual shunt was evidenced in four patients(8.5%),small residual shunt was found in two patients(4.3%),and trace residual shunt in one patient(2.1%).Compared to preoperative conditions,the right atrium diameter and end diastolic right ventricle diameter were decreased at 6-month and 12-month after operation(all P<0.05).At 1 year after the operation,the atrial level shunt was reduced from 7 mm before discharge to 5 mm in one patient;both the trace and small residual shunts detected before discharge disappeared,and 4 patients with moderate residual shunts at discharge were reduced to small residual shunts.The complete occlusion rate was 89.4%(42/47)at 1 year.Conclusions:TTE-solely guided percutaneous closure of complex ASD is feasible and maintains the advantages of safety and minimal invasiveness of the traditional percutaneous interventional therapy,while avoids radiation exposure for patients and operators.