用Amplatzer房间隔封堵器堵闭边缘不足的房间隔缺损效果观察  

Transcatheter closure of secundum atrial septal defect with deficient rims using the Amplatzer septal occluder.

作　　者：杜忠东 [1] Cao Qiling  Ziyad M Hijazi  

机构地区：首都医科大学附属北京儿童医院,100045[1] 美国芝加哥大学儿童医院[2]

出　　处：《中国实用儿科杂志》2005年第3期154-157,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的　探讨用Amplatzer房间隔缺损封堵器经导管堵闭部分边缘缺乏或不足(<5mm)的房间隔缺损的可行性。方法　1999年7月至2 0 0 1年9月对芝加哥大学儿童医院的2 3例边缘<5mm的房间隔缺损患儿试用Amplatzer封堵器进行堵闭,其中男10例,女13例,平均年龄10 7岁。2 0例经食管超声心动图或心内超声心动图测量的房间隔缺损前缘0～4mm ,2例下缘为2mm ,1例后缘为2mm。同期,4 8例房间隔缺损边缘>5mm的患儿作对照。结果　全部2 3例边缘<5mm的房间隔缺损患儿和4 8例对照儿均成功安装了封堵器。两组间年龄、缺损大小和所用封堵器大小差异无显著性意义(P >0 . 0 5 )。2 3例边缘<5mm的患儿中17例(73. 9% )即刻完全堵闭,对照组4 4例(91 .7% )即刻完全堵闭(P <0 .0 5 ) ;2 4h复查边缘<5mm患儿及对照组的完全堵闭率分别是91 3%和93 8% (P >0. 0 5 ) ;6个月复查两组完全堵闭率分别是95 7%和95 8% (P >0 . 0 5 )。缺损边缘<5mm患儿及对照组手术时间分别为(72 . 5±2 6 .5 )min和(6 1. 4±2 1 .9)min ;X线暴光时间分别为(12 .6±7 .0 )min和(9. 8±4 . 2 )min ,与对照组比较手术时间稍长。两组患儿术中和术后均未出现并发症。结论　前、后或下缘<5mm的房间隔缺损仍可以用Amplatzer房间隔缺损封堵器经导管堵闭。Objective This study sought to evaluate the feasibility of trancatheter closure of secundum atrial septal defect (ASD) associated with deficient rims (<5mm) using the Amplatzer septal occluder (ASO).Methods Twenty-three patients (13 females/10 males,median age 10.7 years) with an ASD associated with deficient rims underwent an attempt of transcatheter closure from 1999 to 2001.The patients had either a deficient anterior rim of 0～4mm ( n =20),inferior rim of 2mm ( n =2) or posterior rim of 2mm ( n =1) as assessed by transesophageal or intracardiac echocardiography.During the same period,48 patients with sufficient rims (>5mm) who underwent transcatheter closure of ASD using an ASO served as controls.Results Devices were successfully deployed in all 23 patients with deficient rims and 48 patients with sufficient rims.There were no differences between the two groups in ASD stretched diameter and device size ( P >0.05).Of 23 patients with deficient rims,17 (73.9%) had immediate complete closure compared to 44 (91.7%) of 48 with sufficient rims ( P <0.05).However,at 24-hour and 6-month follow-up,the complete closure rates were not significantly different between the two groups (91.3% for patients with deficient rims vs 93.8% for patients with sufficient rims at 24 hours and 95.7% vs 95.8% at 6 months).The fluoroscopy time and procedure time were longer in patients with deficient rims [(12.6±7.0)min and (72.5±26.5)min,respectively]compared to those with sufficient rims [(9.8±4.2)min and (61.4±21.9)min,respectively].No major complications were encountered either during or after the closure procedure in both groups.Conclusion Transcatheter closure of ASDs associated with small anterior,inferior or posterior rims is feasible using an ASO.Long-term follow-up data is still needed for the long-term safety and efficacy.

关 键 词：房间隔缺损 介入性治疗 心导管术 超声心动图 

分 类 号：R72[医药卫生—儿科]