胸部小切口非体外循环治疗先天性心脏病房间隔缺损

Closure of atrial septal defect with occluder by minimally invasive and non-extracorporeal circulation ways

目的 探索经胸部微创新术式置入新型房间隔缺损闭合器的方法。 方法 34例房间隔缺损 ,全麻下经右胸壁胸骨旁第四肋间 2cm～ 3cm的小切口入胸 ,经右房置入Dasdo圆形或椭圆形闭合器。经食管超声心动图术中观测各切面观房间隔缺损大小及周缘情况 ,选择闭合器类型及大小。超声监测下于房间隔缺损两侧释出闭合器双伞 ,确认牢固及无明显房水平分流后释放闭合器、关胸。 结果 33例房间隔缺损患者封闭成功 ,1例失败 ,改为体外循环下房间隔缺损修补术。房间隔缺损最大径为(8～ 32 )mm ,(19 3± 6 3)mm。房间隔缺损各方向缘最短者分别为距主动脉后壁无缘 ,距上腔静脉3 5mm ,距下腔静脉 6 0mm ,距二尖瓣根部 6 .0mm。超声引导下封闭房间隔缺损过程约 2min～ 3min。 结论 经胸小切口置入房间隔缺损闭合器是一种治疗房间隔缺损的新术式 ,该方法闭合房间隔缺损的适应证可能更广泛。

Objective To explore the method of atrial septal defect (ASD)occlusion with occluder by minimally invasive chest ways. Methods 34 patients with ASD were anaesthetized and a 2cm～3cm-long incision was made in the 4th intercostal space of right side of sternum and a Dasdo round or elliptic occluder was placed in the heart.The ASD size and edge in various sections were measured by transesophageal echocardiography,and the type and size of occluder were accordingly selected.Two umbrellas were opened on two sides of ASD under monitoring of echocardiography.After confirming the firm of occluder and no evident atrial shunt,occluder was released,and right atrium and chest were sewed. Results 33 patients with ASD were successfully occluded and one case was failed who received extracorporeal circulation operation.The maximum diameter of ASD was 8～32(19 3±6 3)mm.The shortest edge in variant side was 0 mm to posterior wall of aortea,3.5mm to superior vena cava,6.0mm to inferior vena cava and 6.0mm to the base of mitral valve.The time for closing ASD guided by echocardiography was about 2～3 minutes. Conclusions The placement of ASD occluder through minimal incision of the chest is a new method for the treatment of ASD.It might have wider indications for ASD occlusion.