心腔内超声心动图监测下经导管堵闭腔静脉型房间隔缺损临床研究  

Clinical study of transcatheter closure of vena cava type atrial septal defect under intracardiac echocardiographic guidance

作　　者：李虹[1] 张智伟[1] 钱明阳[1] 李渝芬[1] 曹期龄[2] 

机构地区：[1]广东省心血管病研究所,广东广州510100 [2]美国芝加哥大学儿童医院

出　　处：《中国实用儿科杂志》2008年第9期658-660,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨腔静脉型房间隔缺损（ASD）在心腔内超声心动图（ICE）监测下经导管堵闭的安全性和有效性。方法2006年10月至2007年4月，广东省人民医院心儿科应用ICE监测经导管堵闭继发孔型ASD18例，其中腔静脉型ASD12例（67％）。男2例，女10例。年龄2-11岁，平均（6．4±2．8）岁。体重11．0～35．0kg，平均（21．0±7．1）kg。ASD大小：11．6～32．0ram，平均（24．3±6．2）mm，下腔静脉型8例（67％），上腔静脉型4例（33％），Qp／Qs：1．8—4．7，平均（3．4±0．8），肺动脉压力：22～37mmHg，平均（32．3±5．1）mmHg。6例为多发型ASD。对于非圆形大ASD，采用球囊测量ASD伸展径。选择比ASD大0～2mm堵闭器，ICE监测下打开堵闭器左房盘、连接腰部及右房盘，如为下腔静脉型大ASD，采用特殊曲度的鞘管，使左房盘打开后平行于房间隔，于靠近缺损处打开连接腰部堵塞缺损，再迅速打开右房盘。结果全组11例（92％）堵闭成功，堵闭器大小：13～34mm，平均（26．0±6．4）mm；3例少量残余分流，1例堵闭失败，均为多发ASD。无并发症发生。手术时间：60～150min，平均（88．2±24．1）min，X线曝光时间：12～32min，平均（16．0±6．1）min。随访6～12个月，无堵闭器移位、心内膜炎及脑栓塞等发生。结论腔静脉型ASD在ICE监测下经导管堵闭具有可行性。Objective To evaluate the safety and efficacy of transcatheter closure of vena cava type atrial septal defect （ ASD ） under intracardiac echocardiographic （ ICE ） guidance. Methods From October 2006 to April 2007,18 patients with seeundum ASD underwent an attemted transeatheter closure using ICE guidance,of whom 12 （67%） patients （ 10 female/2 male ） were vena cava type. The ages of the patients ranged from 2 to 11 years （ median 6.4 ± 2. 8 years ）. The body weight ranged from 11 to 35 kg （ median 21.0 ±7.1 kg）. The size of ASD ranged from 11.6 to 32.0 mm （ median 24. 3 ± 6. 2 mm ）. There were 8 （ 67% ） patients with inferior vena cava type and 4 （ 33% ） patients with superior vena cava type. The Qp ： Qs ranged from 1.8 to 4. 7 （ median 3.4 ± 0. 8 ）. The pulmonary artery pressure ranged from 22 to 37 mmHg （ median 32. 3 ± 5. 1 mmHg）. Six patients were multiple ASDs. For non-circle ASD, the defect was measured by balloon-stretched diameter. The choice of device size was 0 to 2 mm larger than defect. The device was deployed under ICE guidance. For the large inferior vena cava type ASD, a specially designed sheath （ Hausdorf sheath ） with two curves at its end was used to keep the LA disk parallel to the septum while deploying the connecting waist and RA disk in the defect and right atrium. Results There was successful closure in 11 （92%） patients. The device size ranged from 13 to 34 mm （ median 26 ± 6. 4 mm ）. There was small residual shunt in 3 patients and unseccessful closure in 1 patient among those with multiple ASD. There was no complication. The procedure time ranged from 60 to 150 min （ median 88.2± 24. 1 min）. The fluoroscopy time ranged from 12 to 32 min （ median 16. 0± 6. 1min ）. All patients were followed up for 6 to 12 months, there had been no episodes of device disposition, endocarditis or thromboembolism. Conclusion Transcatheter closure of vena cava type ASD under ICE guidance is feasible.

关 键 词：腔静脉型房间隔缺损 心腔内超声心动图 经导管堵闭术 

分 类 号：R72[医药卫生—儿科]