40岁以上继发孔型房间隔缺损介入治疗的评价

Transcatheter closure of secundum atrial septal defects in patients above 40 years old

目的 :评价 40岁以上继发孔型房间隔缺损 ( ASD)介入治疗的效果。方法 :全组 45例 ,年龄 40～ 65 ( 4 9土 7)岁。术前超声心动图检查 ASD最大直径 8～ 3 8( 2 7土 7) mm。并发高血压 13例 ,糖尿病 2例 ,三尖瓣关闭不全 2 9例 ,二尖瓣关闭不全 8例 ,心房纤颤 4例 ,频发房性早搏 9例。所有病例均经导管置入 Amplatzer ASD封堵器。 1例大小紧邻的两个 ASD,采用一个封堵器关闭两个缺损。 1例两个 ASD相距较远 ,用两个封堵器分别关闭。术后 48h,1～ 3月分别行经胸超声心动图 ( TTE)、心电图及 X线检查。结果 :44例选择的封堵器直径为 10～ 40 ( 3 1土 7)m m。 1例双孔 ASD(分别 8m m和 16mm) ,分别采用 12 mm和 2 0 mm两个封堵器。封堵器置入均获得成功 ,技术成功率为 10 0 % ,术中未发生任何重要并发症 ,无急诊手术病例。术后即刻 ,TTE显示 3例 ( 7% )存在微量至少量残余分流 ;术后 48h TTE显示 2例 ( 4 .4% )存在微量至少量残余分流 ;术后 3月无 1例残余分流。术后右心房、室缩小 ,心功能明显改善。结论 :Amplatzer封堵器适合于 40岁以上继发孔型 ASD的介入治疗 ,具有操作简便、安全。

AIM: To evaluate the therapeutic efficacy of transcather closure of secundum atrial septal defect (ASD) in elderly patients using Amplatzer occluder device. METHODS: There were 46 patients. The age was 49±7 years (ranging from 40 to 65 years). The diameter of ASD was 27±7 mm (ranging from 8 to 38 mm) shown by echocardiography before the interventions. Two cases had double ASD. There were 13 patients with hypertension,2 with diabetes, 29 patients with tricuspid regurgitation, 8 with mitral valve regurgitation, 4 with atrial fibrillation,and 9 with atrial premature beats. Each case was occluded using Amplatzer occluder device through the percutaneous procedure. Echocardiography was performed immediately, and echocardiography, ECG and X ray examination were performed 48 h and 1~3 months after the procedure to evaluate the efficacy. RESULTS: The diameter of the occluder selected was 31±7 mm ( ranging from 10~40 mm ). In one case with double ASD(8 mm and 16 mm),2 occluders, 12 mm and 20 mm respectively, were used. The success rate of the placement of Amplatzer occluder was 100%. No complications occurred during the procedure, and no one needed emergency surgery. Trivial to small residual shunts were found in 3 cases (7%) immediately after the procedure, and in 2 cases( 4%) 48 h after the procedure. No residual shunts was found in 3 months follow up. Echocardiography and X ray examination showed that pulmonary vascularity and heart size were improved. CONCLUSION: Transcatheter closure of secundum ASD using Amplatzer occluder device was an effective nonsurgical method for patients above 40 years old. It had a high successful rate of technique and satisfactory immediate and short term results.