房间隔瘤并发继发孔房间隔缺损的介入治疗评价  

Evaluation of transcatheter closure of atrial septal aneurysm associated with secoundum atrial septal defect

作　　者：张玉顺[1] 李寰[1] 代政学[1] 李军[2] 张军[2] 

机构地区：[1]第四军医大学西京医院心脏内科,陕西西安710032 [2]第四军医大学西京医院超声诊断科,陕西西安710032

出　　处：《心脏杂志》2005年第3期260-262,共3页Chinese Heart Journal

摘　　要：目的:评价房间隔瘤(ASA)并发继发孔型房间隔缺损(ASD)介入治疗的临床效果。方法:全组21(男8,女13)例,年龄9～56(24士14)岁。经临床、心电图、X线及经胸超声心动图(TTE)检查诊断为ASA并发继发孔型ASD。TTE检查ASA均膨入右心房,测量ASD最大直径12～28(19±7)mm。其中单孔ASD13例,多孔ASD8例,孔间距离1～7mm者7例,12mm者1例。结果:21例均一次封堵成功,技术成功率100%。所用封堵器的直径为16～40(25±8)mm。8例多孔ASD,有7例置入1个封堵器直接封堵多个缺损孔,1例(两个缺损孔之间距离为12mm)分别用18mm和12mm两个封堵器封堵。术后即刻TTE检查显示16例获完全闭合,5例有少或微量残余分流,完全堵闭率76%(16/21)。术后3d复查TTE2例(10%)有微量残余分流。1～6个月复查19例(90%)心脏大小恢复正常,2例(10%)并发心房纤颤患者心脏不同程度的缩小,1例有微量残余分流。1年后随访12例,无封堵器移位及其他并发症。结论:介入治疗房间隔瘤(ASA)并发继发孔型ASD具有操作简便、安全、技术成功率高及封堵效果好等优点。AIM: To evaluate the effects of transactheter closure of atrial septal aneurysm (ASA) associated with secoundum atrial septal defect (ASD). METHODS: Total 21 (8 male, 13 female) patients, aged from 9 to 56 (average, 24±14) were investigated. All patients were diagnosed of ASA associated with ASD by physical examination, ECG, X-ray and TTE. ASAs were all convexed into right atrial. The largest diameter of ASD was from 12 to 28 (average, 19±7) mm. 13 cases with single hole ASD, and 8 cases with multiple holes ASD. 7 cases with the distance between each ASD holes were from 1 to 7 mm, and 1 case with the distance between each ASD holes was 12 mm. RESULTS: Total 21 cases were all successfully occluded just for once, the technique success rate was 100%. The size of implanting occluders were from 16 to 40 (average, 25±8) mm. In 8 cases with multiple ASD, 7 cases implanted only one occluder to close multiple ASD holes, another 1 case, in which the distance between each ASD holes were 12 mm, were closed by implanting two occluders (18 mm,12 mm occluder,respectively). Immediately after occlusion, examined by TTE, ASD was completely closed in 16 cases, and micro to small residual shunt was found in another 5 cases. The complete closure rate was 76% (16/21). 3 d after occlusion, examined by TTE, residual shunt was found in 2 cases (10%). During 1~6 months follow-up, heart size resumed to normal in 19 cases (90%); and another 2 cases(10%) with atrial fibrillation, heart sizes were decreased; micro residual shunt was found in 1 case. 12 cases during 1-year follow-up, none was found occluder shift and other complications. CONCLUSION: Transcatheter closure of ASA associated with ASD is safe, easy to operate, with high technique success rate and good result.

关 键 词：房间隔瘤 房间隔缺损 介入治疗 封堵器 

分 类 号：R541.1[医药卫生—心血管疾病]