国产封堵器经导管介入治疗巨大房间隔缺损的疗效  

Efficacy and follow-up of transcatheter occlusion of large atrial septal defect by a Chinamade atrial septal occluder

作　　者：马东星[1] 吴晓霞[1] 李卉[2] 刘惠亮[1] 张蛟[1] 穆磊[1] 王冉冉[1] 姚宏英[1] 赵旭燕[1] 

机构地区：[1]武警总医院心内科,北京100039 [2]武警总医院南一科,北京100039

出　　处：《武警医学》2010年第8期672-675,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨使用国产封堵器介入治疗巨大房间隔继发孔缺损(atrial septal defect,ASD)的可行性和安全性。方法经胸/经食管彩色多普勒超声心动图证实巨大ASD患者62例,在经胸超声心动图及X线透视监护下,根据ASD边缘不足情况分别制定封堵策略,选用国产封堵器行介入封堵治疗,记录围术期并发症,随访复查7d、6个月、18个月经胸多普勒超声心动图、心电图和胸片和临床事件(心包填塞、心脏破裂、血栓、感染性心内膜炎和死亡)。结果 56例巨大继发孔ASD经导管封堵成功,成功率90.3%。6例患者试封堵失败,根据分型分别为后缘并下腔静脉缘不足型3例,主动脉缘并下腔静脉缘不足型3例。围术期并发症包括封堵器脱落2例、房间隔残缘断裂1例,3例患者均行外科手术、取出封堵器/房间隔补片修补术。一过性ST段抬高和一过性黑矇各1例。术中及随访期间无临床事件发生。结论巨大ASD可以行介入封堵治疗,国产封堵器介入封堵巨大房间隔缺损患者安全、有效、并发症少、费用低,可作为有封堵适应证患者的首选方案。Objective To evaluate the safety and efficacy of the transcatheter occlusion of a large secundum type atrial septal defect with edge - insufficiency by a homemade septal occluder. Methods sixty - two patients with large secundum type atrial septal defects were confirmed by transthoracic and transesophageal color Doppler echocardiograpby. In some of these cases, it was confirmed that edge insufficiency ranges from 0 to 4mm at least one side and without any utility support edge. Transcatheter closure of atrial septal defects with the homemade septal occluder was monitored by transthoracic or transesophageal color Doppler echocardiography and X - ray fluoroscopy. Then we selected home - made occlusion devices. Electrocardiogram （ ECG ） , transthoracic echocardiography （ TIRE） and X-ray check were used for assessment before and after the procedure. Follow - up examinations were conducted 1 week , 6 months and 1.5 years later. Complications and clinic events were recorded. Results In 56 of the 62 cases, defects were occluded successfully , with a success rate of 90.3% . Occlusion was unsuccessful in 6 cases , whose defects were of posterior shape with inferior vena cava edge - insufficiency in three cases, and of aortic shape with inferior vena cava edge - insufficiency in other three cases. There were complications in 3 patients. No other complications, such as emholization, infective endocarditis, cardiac perforation, or migraine, were observed. Conclusions Large secundum type atrial septal defects can be occluded by interventional treatment. Homemade interventional occluders for large atrial septal defects are safe, effective, and inexpensive with few complications, and can be used as a preferred option in patients with occlusion indications.

关 键 词：巨大房间隔缺损 介入治疗 国产封堵器 

分 类 号：R542.5[医药卫生—心血管疾病]