介入治疗巨大房间隔缺损的临床研究  

Clinical research of interventional therapy Large atrial septal defect

作　　者：郭建军[1] 王志斌[1] 张涌[1] 梁智星[1] 梁法禹[1] 

机构地区：[1]山西医科大学第一医院心胸外科,030001

出　　处：《心肺血管病杂志》2014年第3期337-340,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:评价应用Amplatzer ASD封堵器介入治疗巨大房间隔缺损(ASD)的疗效。方法:所有患者均在X线透视和经胸超声心动图(TTE)监测下,按照TTE所测的ASD最大伸展直径加4~8mm或者按所选封堵器周径﹥ASD周径的1/8~1/10选择Amplatzer ASD封堵器,操作采用"心房法"。术后随访行TTE、胸X片线及心电图检查,观察Amplatzer ASD封堵器的位置、形状及与相邻瓣膜的关系,了解肺血及心胸比例的情况,以评价其疗效及安全性。结果:63例ASD中,60例封堵成功,成功率为95.2%。术后即刻行TTE检查有6例存在少量残余分流,均于术后72h^3个月内消失;18例合并肺动脉高压患者术后3个月肺动脉压力均有不同程度下降;52例合并三尖瓣关闭不全及16例合并二尖瓣关闭不全患者术后3个月均有不同程度好转;早期有7例患者出现阵发性室上性心律失常,于出院前全部自行消失;术前8例心房颤动者术后有4例转为窦性心律;术前13例患者合并有完全或不完全性右束支传导阻滞,9例消失于术后6个月内,其余4例成为永久性。所有患者X线平片显示:肺血不同程度减轻,心胸比例不同程度缩小。所有成功封堵患者术后封堵器无组织反应、无金属反应,封堵器位置准确稳定,装置无变形及折断,无血栓形成及溶血等严重并发症的发生。结论:应用Amplatzer ASD封堵器封堵巨大ASD是安全的,有效的,但在操作中应注意防止封堵器脱落并发症的发生。Objective：To evaluate the application of Amplatzer ASD occlude interventional therapy Large atrial septal defect. Methods： All patients were in X-ray fluoroscopy and transthoracic eehocardiography （TYE） monitoring, according to the measure of the ASD TIE maximum diameter and 4-8mm stretch or according to the occluder circle diameter more than ASD circle diameter of 1/8-1/10 to choose occluder, operation using Atrial method. Follow-up TIE, chest X-ray and cardiogram, observe the position and shape of occluder, and observe the relationship of adjacent heart ales, the cardiothoracic ratio and lungs blood, to evaluate its effec tiveness and safety. Results： 63 ASD,60 cases success rate, sealing 95.2%. TIE do check immediately after postoperation, six cases existing a small residual shunt and 72h-3 months to disappear, 18 cases of patients with pulmonary arterial hypertension merge after 3 months of pulmonary artery pressure drop in different degree, 52 cases of combined tricuspid regurgitation and 16 cases of combined mitral valve insufficency after 3 months different degree was improved, Early has seven patients appeared paroxysmal SAs-supraentricular arrhythmias and all disappear before discharge; Preoperative 8 cases of atrial fibrillation 4 cases to the postoperative sinus rhythm, Preoperative 13 patients with complete or incomplete right bundle branch block, 9 cases disappear in 6 months postoperatively, the four cases of permanent. All patients X-ray shows： lung, reduce blood different proportion of different levels. All successful sealing patients, no tissue reaction, no metal reaction, occluder location accuracy, the device without deformation and broken, without thrombosis and hemolysis severe complica-tions. Conclusion ： The application of Amplatzer ASD occluder sealing large ASD is safe, effective, but in operation should be paid attention to in the occluder off to prevent the occurrence of complications.

关 键 词：先天性心脏病 巨大房间隔缺损 介入治疗 

分 类 号：R54[医药卫生—心血管疾病]