超声引导下经胸或经皮房间隔缺损封堵81例报告  

Transthoracic or Percutaneous Atrial Septal Defect Closure Guided by Echocardiography:Report of 81 Cases

作　　者：刘健[1] 唐先成[1] 黄击修 林小彬[1] Liu Jian;Tang Xiancheng;Huang Jixiu(Department of Cardiovascular Surgery,People’s Hospital of Jianyang,Jianyang 641400,China)

机构地区：[1]简阳市人民医院心血管外科,简阳641400

出　　处：《中国微创外科杂志》2019年第2期124-126,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨超声引导下经胸或经皮房间隔缺损(atrial septal defect,ASD)封堵的疗效。方法 2009年7月～2017年12月81例ASD在超声引导下经胸或经皮封堵,其中52例采取胸骨右缘第3或4肋间小切口,经右心房途径封堵ASD,29例经股静脉穿刺,血管内途径封堵ASD。结果经胸封堵52例,其中封堵顺利43例,封堵不顺利4例,封堵失败5例;经皮封堵29例,其中封堵顺利25例,封堵不顺利3例,封堵失败后改经胸封堵1例。73例随访0.5～6年,平均3.6年,未见封堵伞移位、脱落、明显残余分流以及其他并发症发生。结论 ASD直径>25 mm最好选用经胸封堵以避免使用过大封堵伞;ASD直径≤25 mm,尤其是≤3 mm最好选用经皮封堵;ASD直径≥35 mm最好放弃封堵。Objective To analyze the efficacy of transthoracic or percutaneous atrial septal defect ( ASD) occlusion guided by echocardiography.Methods From July 2009 to December 2017,there were 81 cases of transthoracic or percutaneous closure of ASD.Among them,52 cases were treated with small incision at the right sternal margin at the third or fourth intercostal space for ASD occlusion through right atrial approach,while 29 cases were given femoral vein puncture for ASD occlusion via intravascular approach.Results In 52 cases of transthoracic closure surgery,the operation was successfully completed in 43 cases,was difficult to perform in 4 cases,and failed in 5 cases.In 29 patients underwent percutaneous ASD occlusion surgery,the operation was successfully completed in 25 cases,was difficult to perform in 3 cases,and failed in 1 case which was converted to transcatheter closure.A total of 73 cases were followed up for 0.5 - 6 years ( mean,3.6 years).No occluder displacement or exfoliation,obvious residual shunt or other complications occurred.Conclusions For ASD diameter > 25 mm,transthoracic closure is the best choice to avoid the use of large occluder.For ASD diameter ≤ 25 mm,especially ≤3 mm,percutaneous closure surgery is the best choice.When the ASD diameter ≥ 35 mm,it is best to give up the closure operation.

关 键 词：房间隔缺损 超声心动图 封堵伞 

分 类 号：R654.2[医药卫生—外科学]