经导管植入封堵器治疗儿童多发房间隔缺损疗效评价  

Transcatheter device closure of multiple secundum atrial septal defects in children: procedural and clinical outcomes

作　　者：许伟滨[1,2] 张智伟[1,2] 张旭[1,2] 袁雪梅[1,2] 

机构地区：[1]广东省心血管病研究所 [2]广东省人民医院 广东省医学科学院,广州510080

出　　处：《岭南心血管病杂志》2013年第4期441-445,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨经导管植入封堵器治疗小儿多发房间隔缺损的可行性,并对其短期疗效进行初步评价。方法44例经胸超声心动图检查确诊多发房间隔缺损的患儿[男14例,女30例,年龄4(2～14)岁]于X线和经胸超声心动图监测下植入房间隔缺封堵器,术后复查经胸心脏超声心动图、心电图及X线胸片评估初步疗效,并通过随访分析评估短期疗效。结果44例患儿中,39例为2孔房间隔缺损,5例为3孔房间隔缺损。大缺损直径为(13.0±4.7)mm,小缺损直径为(5.4±2.3)mm;缺损之间间隔长(5.1±2.4)mm;所选择封堵器大小为(17.7±5.7)mm。44例均根据经胸超声心动图测量结果选择封堵器,5例植入2个封堵器,余39例植入一个封堵器,采用封堵器直径为(22±7)mm。封堵器植入均成功,在术中、术后及随访中所有患儿均无严重并发症。随访时间3个月～1年,所有患者的封堵器位置良好,心电图检查均未见心律失常发生。右心房舒张末期内径由术前的(29.2±5.8)mm降至术后6个月的(25.6±4.3)mm,差异有统计学意义(P<0.05);右心室舒张末期内径由术前的(28.2±5.7)mm降至术后6个月的(24.78±5.33)mm,差异有统计学意义(P<0.05)。术后即刻及24 h复查经胸超声心动图有6例(13.6%,6/44)少量残余分流和10例(22.7%,10/44)有中量残余分流,1例(2.3%,1/44)(5 mm)大量残余分流,成功率为75%(33/44)。6个月随访有3例(6.8%,3/44)患儿存在少量残余分流,6例(13.6%,6/44)存在中量残余分流,1例(2.3%,1/44)(4.1 mm)存在大量残余分流,封堵成功率为84.1%(37/44)。一年随访时有2例(6%,2/33)患儿存在少量残余分流,2例(6%,2/33)存在中量残余分流(n=33),封堵成功率94%(31/33)。结论经导管治疗多发房间隔缺损是安全的,疗效显著。在短期随访中右心室及右心房舒张末内径显著缩小。Objectives To explore the feasibility and short term outcomes of transcatheter device closure of multiple secundum atrial septal defects （ASD） in children. Methods Totally 44 pediatric patients diagnosed as multiple secundum ASD by transthoracic echocardiography（TlTE）, including 14 males and 30 females at the age of 4 （2-14） years, were enrolled in this study. With the guidance of TIE and X-ray, all the patients received occluder devices for closure. TIE, electrocardiography（ECG） and X-ray were performed to evaluate the efficacy. Short-term （3 months to 1 year） follow- up data were analyzed. Results Of the 44 patients, 39 cases were with two defects while 5 cases were with three defects. Diameter of the large defect was （ 13.0±4.7 ） mm ; diameter of the small defect was （ 5.4 ±2.3 ） mm ; length of the defect interval tissue was （5.1±2.4）mm; size of the selected device was （17.7±5.7）mm. Five patients received two occluders while 39 patients were implanted with one occluder. Diameter of the occluder was （22±7）mm. All the patients were implanted successfully and no severe complication was found during implantation or follow-up. All the patients were followed-up for 3 months to 1 year. Position of the devices were good and no arrhythmia occurred. End-diastolic diameter of right atrium （RA） obviously decreased from （29.2±5.8）mm before closure to （25.6±4.3）mm after 6 months （P〈 0.05）. End-diastolic diameter of right ventricle （RV） significantly decreased from （28.2±5.7）mm before closure to （24.78±5.33） mm after 6 months （P〈0.05）. Small residual leaks were presented in 6 cases （13.6%, 6/44）, moderate residual leaks in 10 cases （22.7%, 10/44） and a large residual leak （5 mm） in 1 case （2.3%, 1/44） imrnediatelv and 24 hours after procedure, with a successful closure rate of 75% （33/44）. Small residual leaks were presented in 3 cases （6.8%, 3/44）, moderate residual leaks in 6 cases （13.6%, 6/44） and a large resi

关 键 词：房间隔缺损 超声心动图 经导管封堵 

分 类 号：R541.1[医药卫生—心血管疾病]