应用经胸超声指导成人房间隔瘤并缺损的介入封堵治疗  

Transcatheter closure of atrial septal aneurysm merged with secundum atrial septal defects using Amplatzer septal occluder under guidance of transthoracic echocardiography in adults

作　　者：谢启应[1] 孙泽琳[1] 蒲晓群[1] 李传昶[1] 陈晓彬[1] 邓金华[1] 孟霜媛[1] 杨天伦[1] 

机构地区：[1]中南大学湘雅医院心内科,湖南长沙410008

出　　处：《中国现代医学杂志》2010年第10期1441-1445,1449,共6页China Journal of Modern Medicine

摘　　要：目的评价应用经胸超声和X线指引下行成人房间隔瘤合并缺损的封堵治疗的疗效和安全性。方法 20例成人患者,男4例,女16例,年龄(39.0±11.4)岁;术前经胸超声,部分患者同时行食道超声检查诊断为房间隔瘤合并继发孔房间隔缺损,房间隔瘤基底部宽度11～38mm,平均(21.7±7.7)mm,膨出深度7～11mm,平均(9.1±1.8)mm。合并单孔缺损14例,多孔缺损6例,彩色多普勒显示均为左向右分流。介入术中采用经胸超声和X线指引。术后随访采用经胸超声观察心脏大小、封堵器位置。结果房间隔缺损的直径为7～28mm,平均(15.4±5.7)mm。所有患者均封堵成功,共置入国产房间隔缺损专用封堵器20枚,封堵器直径16～36mm,平均(25.0±5.7)mm。随访3～12个月,所有患者封堵器位置固定,无残余分流。14例患者(70%)心脏大小恢复正常。结论经胸超声心动图结合X线可安全、有效的指引成人房间隔瘤并缺损患者的介入封堵治疗,但影像表现有其特殊性。[Objective]To evaluate the efficiency and safety of transcatheter closure of atrial septal aneurysm （ASA） associated with secundum-type atrial septal defects （ASD） under the guiding of transthoracic echocardiography （TTE） and X-ray fluoroscopy in adults. [Methods]Twenty patients （4 males and 16 females） with the mean age of （39.0 ± 11.4） years, who had ASA merged with secundum ASD and were diagnosed by TTE or combined with transesophageal echocardiography （TEE）, were enrolled in the study. All patients accepted transcatheter closure procedure with Amplatzer occluder under the guiding of X fluoroscopy and TEE, and were followed up with TTE. [Results]The ASA projected to right atrium in all cases, the width of basilar part was 11-38 mm [average （21.7 ± 7.7） mm] and vertical extent was 7-11 mm [average （9.1±1.8） mm]. The largest diameter of ASD was directly measured by TTE in 17 patients and by TTE and TEE in 3 cases. The diameter of ASD was （15.4 ± 5.7） mm （ranging from 7 to 28 mm）. Twenty occluders were successfully placed in all individuals. The diameter of occluder was （25.0 ± 5.7） mm （ranged from 16 to 36 mm）. Immediately after the procedure, ASD was completely closed in all cases. No residual shunt or occluder shifting was found during 3～12 months following up. [Conclusion]Transcatheter closure is feasible and safe for selected patients who have ASA merged with secundum ASDs under the guiding of TTE.

关 键 词：房间隔瘤 房间隔缺损 封堵 经胸超声 

分 类 号：R541[医药卫生—心血管疾病]