房间隔缺损介入治疗封堵器选择的影响因素  

Factors influencing the choice of atrial septal occluder for transcatheter closure of secundum atrial septal defects

作　　者：张玉顺[1] 兰贝蒂[1] 李寰[2] 和旭梅[1] 代政学[2] 王海昌[2] 张军[3] 李军[3] 杜亚娟[1] 

机构地区：[1]西安交通大学医学院第一医院心内科,710061 [2]第四军医大学西京医院心内科 [3]第四军医大学西京医院超声科

出　　处：《中华心血管病杂志》2009年第11期981-985,共5页Chinese Journal of Cardiology

摘　　要：目的探讨房间隔缺损（ASD）介入治疗封堵器选择的影响因素。方法1114例ASD患者，男388例，女726例，年龄2～75（26．3±17．0）岁。按14岁作为儿童与成人的划分点，成人组779例，平均年龄（34．4±13．5）岁；儿童组335例，平均年龄（7．3±3．9）岁。经胸超声心动图测量不同切面缺损大小及边缘长短，根据ASD最大直径选择封堵器，分析不同年龄、缺损形态和边缘大小时，选择封堵器的差别。结果1114例ASD患者，成功封堵1085例，技术成功率为97．4％。1085例患者中，ASD最大直径为（19．7±7．8）mm，所选择的封堵器直径为（25．8±8．9）mm，封堵器与ASD最大直径差值为（6．1±3．4）mm，封堵器／最大直径为1．3：1。成人和儿童组ASD大小相近，但成人组封堵器直径、封堵器加大值明显大于儿童组（P〈0．05）；封堵器／ASD最大直径成人组为1．2～1．8：1，儿童组为1．1～1．6：1。随着缺损直径的增大，成人组选择封堵器的加大值亦增加，但非成比例增加。儿童组随着缺损直径的增大，选择封堵器的加大值有增大的趋势，但差异无统计学意义。ASD的最大直径与封堵器的大小显著相关，成人和儿童组其相关系数分别为0．911和0．944（均P〈0．01）。以ASD最小直径／ASD最大直径的比例来描述缺损的形态，发现随着最小直径与最大直径比值的增大，各组间ASD最大直径或封堵器直径虽无差异，但封堵器加大值明显增大。主动脉侧无缘组选择的封堵器、封堵器加大值明显大于有缘组（均P〈0．01）。结论介入治疗ASD，封堵器选择应以测量的ASD最大直径为主体，尚需参考年龄、缺损的形态及其边缘的状况适当增减。Objective To analyze factors influencing the choice of atrial septal occluder （ASO） for transcatheter closure of patients with secundum atrial septal defect （ASD）. Methods A total of 1114 ASD patients [388 males, aged from 2 to 75 years, mean age （26. 3 ± 17.0） years] were enrolled. Patients were divided to adult （ 〉 14 years, mean 34.4 years, n = 779 ） and child （ ≤ 14 years, mean 7.3 years, n = 335） groups. ASD size in different ultrasound cross-sections was determined by transthoracic echocardiography （rITE）. ASO size was chosen on the basis of the maximum diameter of the defect （MD）. Defect-shapes and rim lengths of ASD, the difference choice of ASO in the two groups were compared. Results MD of the defects ranged from 5 to 40 mm [mean （19.7 ±7.8） mini. ASD was successfully occluded in 1085 out of 1114 patients （97.4%）. Occluder size ranged from 6 to 46 mm[ mean （25. 8 ±8.9） mm] and the difference between occluder size and MD ranged from 2 to 10 mm [mean （6. 1 ± 3.4） mm, ASO/MD ratio 1.3：11. Though the diameter of the defect was similar between the 2 groups, the size of occluder was significantly larger in adult group than that in child group （ ASO/MD ratio 1. 1- 1.6：1 vs. 1.2-1.8： 1, P 〈0. 05）. MD was significantly correlated with ASO in both groups （r =0. 911 and r = 0. 944 in adults and child groups, respectively, all P 〈 0. 01 ）. The size and increment of the occluder used in patients with deficient anterior rims was significantly bigger than patients with sufficient anterior rims （ P 〈 0. 01 ）. Conclusion The maximum diameter of the defect was the major determinant for selecting occluder size and choice of occluder size was also influenced by patient age, defect-shape and defect rim for transcatheter closure of secundum ASD.

关 键 词：房间隔缺损 心脏导管插入术 封堵器 

分 类 号：R686[医药卫生—骨科学]