高龄房间隔缺损堵闭术疗效的超声评价

The evaluation of treatment about transcatheter closure of atrial septal defect in old age adults

目的 应用Amplatzer封堵器堵闭高龄继发孔房间隔缺损 (ASD) ,并进行临床疗效的评价。方法 使用经胸和经食道超声心动图筛选的全组 4 2例患者 ,年龄 5 0～ 73岁 (平均 5 6 6 1± 6 4 8)岁 ,均在X线透视下采用经胸超声心动图监测 ,应用Amplatzer封堵器堵闭ASD ,术后 2 4h行经胸超声心动图复查 ,必要时追踪随访。结果 全部病例均成功堵闭ASD。患者感觉良好 ,未见残余分流、心包填塞、中风等并发症。与术前比较 ,右室常规和四腔心右室长径缩短 ,三尖瓣返流减轻 ,肺动脉血流速度减慢 ,本组患者尽管均有轻到中度肺高压 ,但文中资料显示均为动力性肺动脉高压。所以 ,术后肺动脉压力减轻或消失。结论 应用Amplatzer封堵器堵闭治疗高龄继发孔型ASD病人 ,在无阻力性肺高压的前提下 ,近期疗效满意。此治疗方法对高龄患者可能是最佳首选治疗措施。

Objectives To evaluate the clinical effectiveness of the procedure of transcatheter closure of secundum atrial septal defects (ASD) with Amplatzer device. Methods 42 adult patients screened by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) (male 10 and 32 female) with secundum ASD were undergone the transcatheter closure of ASD with Amplatzer device on monitoring of X-ray and TTE. They were from 50 to 73 years old (average 56.61±6.48). Follow up were proceed by TTE after operation 24 hours. Results All of cases were occluded successfully with Amplatzer devices. The patients feel better than before. TTE showed all patients without residual shunts and pericardial tamponade and stroke and another complication. After the procedure, the diameter of the right ventricle was less than before the procedure. The tricuspid valve regurgitation was relieved. The pulmonic flow velocity was slowed. The pulmonary hypertension (PH) was relieved. Conclusions Transcatheter closure of ASD is suitable for old age patients without resistance PH. the short-term clinical effectiveness is satisfied .The procedure may be the first choice for the old patients with secundum ASD.