机构地区:[1]上海市胸科医院心内科,200030
出 处:《介入放射学杂志》2005年第5期480-483,共4页Journal of Interventional Radiology
摘 要:目的评价经导管Amplatzer房间隔封堵器(ASO)治疗50岁以上继发孔房间隔缺损(ASD)的临床疗效和安全性。方法回顾性分析41例50岁以上ASD患者,与同期132例50岁以下ASD患者进行对照。两组术前均经胸超声心动图(TTE)筛查确定诊断,并评估右房右室内径和肺动脉收缩压,封堵前经食管超声(TEE)评价缺损大小和与周边组织关系。所有病例在透视及超声引导下经导管置入ASO堵闭ASD,并在术后3个月内随访超声检查。结果TEE测定ASD直径及球囊测定ASD伸展径两组无差异(P分别为0.22和0.07),但术前肺动脉收缩压50岁以上组较高(P<0.05)。两组中分别有40例(4041,97.5%)和127例(127132,96.2%)封堵成功。50岁以上组发生术中心脏压塞2例和术后心衰加重1例,50岁以下组发生封堵器脱落2例,前组患者在介入术中及随访早期更易发生缓慢性心律失常和房性心律失常(P分别为0.05和0.03)。两组术后心超随访示右房、右室内径分别由术前(46.6±8.9)mm、(49.1±10.2)mm和(40.9±9.5)mm、(42.2±8.6)mm缩小至(37.7±9.0)mm、(40.6±12.3)mm和(33.2±10.1)mm、(34.2±9.0)mm,肺动脉收缩压由术前(50.5±13.8)mmHg和(38.6±11.3)mmHg下降至(39.2±12.6)mmHg和(31.2±14.1)mmHg,均较术前有显著差异(P<0.01)。结论Amplatzer封堵器治疗50岁以上ASD患者的技术成功率与年轻患者相仿,短期疗效确切。但术中并发症相对较多,应规范操作程序。而封堵术后中远期效果尚需进一步随访。Objective To elncidate the efficac) and safety of transcatheter closure of secondary atrial septal defect (ASD) with Amplatzer septal oecluder (ASO) in people over 50 years of age. Methods Retrospective comparison of 41 patients (14 males, 27 females) with ASD over 50 years of age ranging from 50 to 75(mean age 55.5 ± 7.6, elder group) was condueled with 132 patients younger than 50 )ears( control group). After diagnosis of ASDs and evaluation of pulmonary artery systolic pressure and right atrial and ventricular dimensions by transthoracic echocardiography (TrE), all patients underwent transesophageal echoeardiography (TEE) for complete assessment of ASD size, margins and anatomic relationship of the defect before closure of ASD. Each case was treated with ASO through the percutaneous transeatheter procedure under fluoroseopy and TIE or TEE. Early follow up(3 months) by echo was taken after the intervention. Results There was no difference of mean defect diameter measured by TEE and the balloon-stretched defect diameter of the ASDs between 2 groups. Pulmonaryartery pressures in elder group were higher than those in )ounger group( P 〈 0.05). Device deployment was successful in 40 cases for elder group and in 127 cases for younger grnup. The procedural successful rate was 97.5qc and 96.2% , respectively ( P = 0.68). Pericardial effusion occurred during the procedure in 2 cases and heart failure got worsen in l case after occlusion in the elder group, and bradyarrhythmia and atrial tacharrhythmias occurred frequently during the procedure and short-term follow-up after ASO implantation ( P = 0.05,0.03 ). There was device embolization in 2 cases in younger group. After procedures, right atrial and ventricular dimensions decreased from (46.6 ± 8.9) mm and (49.1± 10.2) mm to (37.7 ± 9.0) mm and (40.6 ± 12.3) mm ( P 〈 0.01 ) in elder group and from (40.9 ± 9.5) mm and(42.2±8.6) mm to (33.2 ± 10.1) mm and (34.2±9.0) mm in t
关 键 词:房间隔缺损 封堵术 老年 AMPLATZER封堵器 继发孔型房间隔缺损 50岁以上 介入治疗 AMPLATZER房间隔封堵器 临床分析 肺动脉收缩压 ASD直径 继发孔房间隔缺损
分 类 号:R541[医药卫生—心血管疾病]
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