多孔筛状房间隔封堵器封堵小儿多孔型房间隔缺损  

Closure of fenestrated atrial septal defect by amplatzer cribriform occluder in children

作　　者：王鉴[1] 陈笋[1] 孙锟[1] 武育蓉[1] 谢静[1] 杨健萍[1] 

机构地区：[1]上海交通大学医学院附属新华医院小儿心血管科,上海200092

出　　处：《中国介入心脏病学杂志》2014年第11期685-688,共4页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(30772349;81070134);上海市卫生局系统主要疾病联合攻关项目(2013ZYJB0016);上海市科学技术委员会产学研医合作项目(12JC1406600)

摘　　要：目的介绍使用多孔筛状房间隔封堵器(amplatzer cribriform occluder,ACO)封堵多孔型房间隔缺损(multi-fenestrated ASD,mf ASD)的经验,并评估其可行性、有效性及安全性。方法回顾2013年8月至2014年5月上海交通大学医学院附属新华医院使用ACO经导管介入封堵mf ASD的5例患儿,并介绍手术及术后随访结果。结果 3例mf ASD(Ⅱ)患儿2处缺损距离分别为5 mm、7.4 mm和3.8 mm,选择25 mm ACO进行封堵。1例ASD(Ⅱ)4.5 mm、2.0 mm(位置略偏前),选择18 mm ACO。1例房间隔瘤形成,瘤底8.5 mm,瘤高12.2 mm,ASD 2处,一处位于中央8 mm×8 mm,另一处位于房间隔瘤下方,大小为2.5 mm,两处缺损相距5.2 mm,选择25 mm ACO。术中及术后超声心动图均显示无残余分流,术后第2天及1、3个月心电图检查结果均正常。短期随访结果令人满意,尚未见并发症发生。结论 ACO应用于封堵mf ASD操作简便,并发症少,封堵效率较高,是患儿mf ASD封堵的选择之一。Objective To introduce the initial experience of closing multi-fenestrated atrial septal defect（ mf ASD） by Amplatzer Cribriform Occluder（ ACO）,and evaluate its effectiveness,efficacy and safety. Methods To review five cases that used ACO for mf ASD closure from Aug 2013 to May 2014,introduce catheterization procedures and evaluate short-term follow-up outcomes. Results The characteristics of echocardiography and the choices of occluders of the five patients are displayed respectively as： In case 1,ASD（ Ⅱ） 7 mm,4. 8 mm,5 mm apart,8 F delivery sheath,25 mm ACO used. In case 2,ASD（ Ⅱ）5. 0 mm,2. 7 mm,8 F delivery sheath,25 mm ACO used and inter-atrial aneurysm was formed,with bottom length of 8. 5 mm and height of 12. 2 mm. In case 3,ASD（ Ⅱ） × 2,one defect was 8 mm × 8 mm and located underlying the inter-atrial aneurysm,the other defect was 2. 5 mm and located below the aneurysm,8 F delivery sheath,25 mm ACO were used. In case 4,ASD（ Ⅱ） 2. 4 mm,2. 4 mm,7. 4 mm apart,7 F delivery sheath,25 mm ACO used. In case 5,ASD（ Ⅱ） 4. 5 mm,2. 0 mm,8 F delivery sheath,18 mm ACO used. We built routine arteriovenous pathways and released ACOs regularly in all five cases. Intraoperative and postoperative echocardiography showed no residual shunt,and electrocardiograms were normal the next day after catheterizations. The current short-term follow-up was satisfactory and showed no complications. Conclusions ACO might become a better alternative to close mf ASD for proper patients for its easy deployment,fewer complications,less interference with venous blood flow and atrioventricular valves function.

关 键 词：多孔筛状房间隔封堵器 多孔型房间隔缺损 房间隔瘤 

分 类 号：R541.1[医药卫生—心血管疾病]