小儿房间隔缺损介入治疗40例临床报告

Transcatheter closure of atrial septal defects in 40 pediatric patients

目的 评价小儿继发孔型房间隔缺损 (ASD)应用美国AGA公司的Amplatzer封堵器介入治疗的临床疗效。方法 II孔型ASD 4 0例。男 16例 ,女 2 4例 ;年龄 3～ 15岁 ,平均 10 2岁。体重11～ 87kg ,平均 35 8kg。 6例合并肺动脉瓣狭窄 (PS) ,1例合并二尖瓣脱垂和轻度关闭不全 ,1例合并室性心动过速 (VT)。 4 0例均采用美国AGA公司的AmplatzerASD封堵器。术中常规行右心导管检查 ,测量右室、肺动脉压力。经导引钢丝导入球囊导管测ASD最大伸展直径。用体表经胸超声心动图 (TTE)或食道超声 (TEE)测量房间隔直径及确定ASD的位置及大小。根据球囊最大伸展直径选择等于或大于 1～ 2mm型号的ASD封堵器。结果 4 0例患儿应用 4 0个Amplatzer封堵器封堵成功 ,成功率 10 0 %。经TTE测量ASD直径为 7～ 30mm(平均 17 12mm) ,TEE测量直径为 7～ 32mm(平均18 4 4mm)。最大球囊伸展直径为 8～ 34mm(平均 2 0 5 6mm)。Amplatzer封堵器型号 8～ 38mm(平均2 1 4 4mm)。合并PS ,先行球囊扩张术 ,成功后再封堵ASD。合并VT先行射频消融术而后成功封堵ASD。 4 0例无并发症 ,无残余分流。术后 3～ 4天出院。术后 3d复查ECG、TTE及X线胸部检查有明显改善。结论 AmplatzerASD封堵器封堵小儿ASD是安全、有效的。规范化治疗 。

Objective To evaluate the clinical effiancy of transcatheter closure of atrial septal defect (ASD) with AGA-Amplatzer occlusion device in pediatric patients. Methods Forty patients with ASD,16 males, 24 females, at a mean age of 10.2 years (ranged from 3 to 15 years of age) and with a mean weight of 35.8 kg (ranged from 11 to 87 kg) were studied. Six cases were complicated with pulmonary stenosis (PS), 1 was complicated with ventricular tachycardia (VT). Right heart catheterizations were done in 40 patients for measuring the pressures of right ventricle and pulmonary artery. The balloon diameter of ASD was measured using balloon catheter with guiding wire. The diameter of ASD was measured by TTE and /or TEE, ascertaining the location and size of ASD. Amplatzer occlusion device was sized to be equal to or 1-2mm more than the diameter of balloon streched. Results All patients had successful implantation of the Amplatzer device. The success rate was 100%. The diameter measured by TTE was 7-30 mm (mean 17.12 mm). The diameter measured by TEE was 7-32 mm (mean 18.44 mm). The diameter of balloon stretched of ASD was 8-34 mm. Of the 40 cases, 6 were complicated with PS and accepted percutaneous balloon valvuloplasty (PBPV). One case was complicated with VT and accepted radiofrequency catheter ablation (RFCA). Neither complication nor residual shunt was found in any of the patients. The patients were recovered and followed up for 3 or 4 days after deployment of the Amplatzer device. Clinical symptom, cardiac murmur, and findings in ECG, echocardiography and X-ray were improved markedly. Conclusion AGA-Amplatzer occlusion device is safe and efficient in pediatric patients with ASD.