合并非经典适应证的多发性房间隔缺损介入治疗  

Interventional treatment of multiple atrial septal defect with non-classical indications

作　　者：周泽明 梁锦标 郑宏[1] 宋会军[1] 李世国[1] 闫朝武[1] 胡海波[1] 池博 魏国亚 刘琼[1] 徐亮[1] 徐仲英[1] 吕建华[1] 乔树宾[4] 宫海波 Zhou Zeming;Liang Jinbiao;Zheng Hong;Song Huijun;Li Shiguo;Yan Chaowu;Hu Haibo;Chi Bo;Wei Guoya;Liu Qiong;Xu Liang;Xu Zhongying;Lyu Jianhua;Qiao Shubin;Gong Haibo(Department of Structural Heart Disease,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical Collage,Beijing 100037 China;Department of Cardiology,Gao’an People’s Hospital of Jiangxi Province,Gao’an 330800 China;Department of Thoracic Surgery,Beijing Royal Integrative Medicine Hospital,Beijing 102209 China;Department of Coronary Heart Disease,Fuwai Hospital,Chinese Academy of Medical Scienc-es&Peking Union Medical Collage,Beijing 100037;Ningbo Trando 3D Medical Technology Co.,Ltd.,Ningbo 315336,China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院结构性心脏病病区,100037 [2]江西省高安市人民医院心内科,高安330800 [3]北京王府中西医结合医院胸外科,102209 [4]中国医学科学院北京协和医学院阜外医院冠心病病区,北京100037 [5]宁波创导三维医疗科技有限公司,315336

出　　处：《中华实验外科杂志》2020年第4期624-626,共3页Chinese Journal of Experimental Surgery

基　　金：国家重点研发计划资助(2018YFB1107100)。

摘　　要：目的探讨合并下腔型或边缘极短等非经典适应证之多孔型房间隔缺损(ASD)进行介入治疗的可行性。方法选择合并2014年9月至2019年9月间中国医学科学院阜外医院上述非经典适应证的多孔型ASD术前先行多排螺旋计算机断层扫描(MDCT)检查及3D模型打印,对其中缺损大小合适者10例行介入治疗并收集其临床及随访数据。组间比较采用配对t检验。结果 10例患者介入治疗均获得成功,其中9例植入动脉导管未闭(PDA)和ASD封堵器各1枚,1例植入2枚ASD和1枚PDA封堵器。10枚PDA封堵器型号为(16/14~32/30) mm,平均为(23.80±5.85)/(21.80±5.85) mm;11枚ASD封堵器型号为(10~36) mm,平均(23.27±7.91) mm。术后均未出现明显并发症。术后随访的X线心胸比(0.44±0.02)较术前(0.50±0.03)明显降低(t=5.670,P<0.05)。经胸超声心动图(TTE)右室前后径[(26.60±3.69) mm]较术前[(33.20±6.00) mm]明显降低(t=5.250,P<0.05),差异有统计学意义。结论采用PDA封堵器和ASD封堵器封堵非经典适应证的特殊类型多孔型房间隔缺损安全有效。Objective To explore the feasibility of interventional treatment for multiple atrial septal defect(ASD)with non-classical indications such as inferior sinus venosus multiple ASD or extremely short rim special types of multiple ASD.Methods The above-mentioned special types of multiple ASD were subjected to multidetector computed tomography(MDCT)examination and 3D model printing performed before operation.Ten patients with appropriate defect size were treated with interventional therapy,and clinical and follow-up data were collected.Results The interventional treatment was done successfully in all 10 patients.One patent ductus arteriosus(PDA)occluder and one ASD occluder were implanted in 9 patients,and 2 ASD occluders and 1 PDA occluder were implanted in one patient.The size of 10 PDA occluders is(16/14-32/30)mm and the average is(23.80±5.85)/(21.80±5.85)mm;the size of 11 ASD occluders is(10-36)mm and average is(23.27±7.91)mm.There were no obvious complications occurred.Compared with the preoperative(0.50±0.03),the X-ray cardiotho racic ratio of postoperative(0.44±0.02)was significantly decreased(t=5.670,P<0.05).The anterior-posterior diameter of transthoracic echocardiography(TTE)[(26.60±3.69)mm]was significantly lower than that before surgery[(33.20±6.00)mm,t=5.250,P<0.05].Conclusion It is safe and effective to use PDA occluder and ASD occluder to close the special types of multiple ASD with non-classical indications.

关 键 词：房间隔缺损 动脉导管未闭封堵器 3D打印 介入治疗 

分 类 号：R541.1[医药卫生—心血管疾病]