同期行经皮左心耳封堵术与房间交通封堵术的临床研究  

Study of simultaneous occlusion of interatrial communication followed by percutaneous left atrial appendage closure

作　　者：王建铭[1] 崔春生[1] 盛晓棠[1] 王琦光[1] 张端珍[1] 李璟昊 朱鲜阳[1] WANG Jian-ming;CUI Chun-sheng;SHENG Xiao-tang;WANG Qi-guang;ZHANG Duan-zhen;LI Jing-hao;ZHU Xian-yang(Department of Congenital Heart Disease,General Hospital of Shenyang Military Region,Shenyang 110016,China)

机构地区：[1]沈阳军区总医院,全军心血管病研究所先心病内科,辽宁沈阳110016

出　　处：《中国介入心脏病学杂志》2018年第10期559-565,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的验证对先天性房间交通伴心房颤动(房颤)患者同期行经导管左心耳和房间交通封堵术的安全性、有效性及短期随访结果。方法根据纳入标准筛选患者,经食管超声心动图(TEE)引导下应用LACBES或ACP2左心耳封堵器行经皮左心耳封堵术,并同期行房间交通封堵术。评价术后即刻、术后1 d、30 d、90 d、180 d的封堵疗效,封堵器形态、位置、并发症及心功能变化。结果共入选18例患者,其中16例应用LACBES、2例应用ACP2左心耳封堵器成功行经皮左心耳封堵术,同期15例行房间隔缺损封堵术,3例行卵圆孔未闭封堵术。术后即刻TEE检查显示封堵器位置满意、固定良好,无残余分流、心包积液相关并发症发生。围术期1例术后30 h出现心脏压塞,术后第5天转外科行封堵器移除及心内修补术。1例术后第17天猝死。其余患者在随访期间无新发心脏压塞、脑血管或外周血管栓塞、出血相关并发症发生。1例术后140 d因心力衰竭再次住院治疗,其余患者术后30 d、90 d经胸超声心动图及术后180 d TEE随访结果良好。结论在先天性房间交通伴房颤患者中,同期行经皮左心耳封堵术与房间交通封堵治疗是可行的,手术安全、有效,短中期随访良好。Objective To evaluate the safety and effectiveness of simultaneous occlusion of intratrial communication followed by percutaneous left atrial appendage closure(LAAC)in patients with congential interatrial communication and atrial fi brillation,and to observe its short-term follow-up outcomes.Methods According to the indications for LAAC,patients with interatrial communication and atrial fibrillation were enrolled(n=18).Under the guidance of transesophageal echocardiography(TEE),LAAC and transcatheter atrial septal defect(ASD)(n=15),or patent foramen ovale(PFO)(n=3)closure were performed.Function of the occluders were evaluated by angiography and TEE immediately after intervention.Complications were also recorded and evaluated perioperatively.The 30-day,90-day and 180-day follow-up outcomes assessed by transthoracic echocardiography(TTE)and TEE were recorded.Results LAAC using 16 LACBES occluders and 2 ACP2 left atrial appendage occluders were successfully performed through the interatrial communication,followed by simultaneously transcatheter interatrial communication closure(15ASD patients and 3 PFO patients,respectively).The position of the occluders was satisfactory and no relevant perioperative complications were recorded immediately after intervention.At 30 hours after intervention,acute cardiac tamponade happened in one patient,and emergency surgeries including removal of the ASD occluder and LAAO,repair of ASD,and hemostasis suture were successfully performed on the fifth postoperative day.One patient died of malignant arrhythmia on the seventeenth day post procedure.There was no devicerelated death.There was no device-related cardiac tamponade,cerebrovascular or peripheral vascular embolism,bleeding,and no thrombosis and peri-occluders leak were observed during the follow-up.One patient was readmitted 140 days after the procedure due to heart failure.Conclusions Our preliminary clinical experience showed that it was feasible to simultaneously perform occlusion of interatrial communication followed by LAAC

关 键 词：房间交通 左心耳 心房颤动 心脏导管插入术 

分 类 号：R541.75[医药卫生—心血管疾病]