房间隔缺损或卵圆孔未闭合并房间隔瘤介入封堵治疗临床经验  

Experience in intervention therapy for atrial septal defect or patent foramen ovale combined with atrial septal aneurysm

作　　者：徐吉喆 江尕学[1] 刘天蕊[1] 白明[1] XU Ji-zhe;JIANG Ga-xue;LIU Tian-rui;BAI Ming(Department of Heart Center,The First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院心脏中心,甘肃兰州730000

出　　处：《中国介入心脏病学杂志》2021年第6期324-328,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨采用超声心动图指导下导丝参比封堵器选择策略及特殊类型房间隔缺损(ASD)封堵器治疗房间隔瘤(ASA)合并ASD/复杂型卵圆孔未闭(PFO)的安全性和有效性。方法回顾性分析2018年1月至2020年1月在兰州大学第一医院行经导管介入封堵治疗的ASA合并ASD/PFO患者。所有患者均于术中加硬导丝通过ASD/PFO建立轨道后使用经胸超声心动图多切面判断ASD各缘回声强度及边缘组织压迫与导丝的关系,据此进行封堵器类型及型号选择,均置入特制小腰大盘型ASD封堵器。于术后1个月及6个月进行随访,以超声心动图评估房室腔变化及心功能、心包积液及器械表面血栓,动态心电图评价房性心律失常,门诊随诊评估有无再发脑梗死。结果共纳入29例患者,其中ASA合并ASD 22例(22/29),ASA合并PFO 7例(7/29),平均年龄(46.97±13.53)岁,其中女性22例(22/29)。所有患者均一次封堵成功,无二次封堵器更换。22例ASD患者使用封堵器直径为6~24 mm;7例PFO患者中5例使用腰部直径6 mm特制小腰大盘型ASD封堵器,2例使用腰部直径8 mm特制小腰大盘型ASD封堵器。双孔及多孔型ASA合并ASD 9例(9/29),最大缺损孔径为5~12 mm;5例患者封堵器释放即刻存在残余分流,均为ASA合并多孔型ASD患者,平均残余分流为(2.20±0.84)mm,2例患者术后6个月随访时残余分流消失。所有患者术前、术后1个月及6个月左心房内径、右心房内径和右心室前后径均未见明显变化,左心室射血分数均未受到影响(均P<0.05);无器械相关血栓、心脏压缩及脑梗死发生,1例患者术后34 h新发阵发性心房颤动。结论ASA合并ASD/PFO患者采用超声心动图指导下导丝参比封堵器选择策略提高了封堵器选择准确率,特制小腰大盘型ASD封堵器可最大限度覆盖ASA、重整房间隔,避免多个封堵器置入,具有安全性及有效性。Objective To investigate the safety and effectiveness of wire reference to occluder sizing under echocardiography and special type of occluder in the treatment of atrial septal aneurysm(ASA)with atrial septal defect(ASD)/complex patent foramen ovale(PFO).Methods Patients of ASA combined with ASD/PFO who underwent transcatheter closure in The First Hospital of Lanzhou University between January 2018 and January 2020 were retrospectively analyzed.All patients after the track established by super still wire,the ECHO intensity of relationship between tissue compression by stiff wire to the edge tissue by transthoracic echocardiography.The special occluder with small waist and large disk was implanted.The patients were followed up for 1 month and 6 months after operation.The alters of atrioventricular cavity,ventricular function,pericardial effusion and device related thrombus(DRT)were evaluated by echocardiography,atrial arrhythmia was evaluated by Holter,and recurrent cerebral infarction was evaluated by outpatient follow-up.Results A total of 29 patients were included,including 22 of ASA with ASD(22/29)and 7 of ASA with PFO(7/29),with an average age of(46.97±13.53)years old,of which 22 cases(22/29)were female.Using the guide wire reference occluder selection strategy under the guidance of ultrasound,all patients were successfully implanted at one time,without secondary occluder replacement.The diameter of occluder ranged from 6 mm to 24 mm.Among the 7 patients with PFO,5 patients were treated with ASD occluder with special occluder diameter of 6 mm and 2 patients were treated with special occluder with diameter of 8 mm.There were 9 cases(9/29)with ASD and 9 cases(9/29)with multiple hole and porous ASA.The largest defect hole was 5-12 mm in diameter.The immediate residual shunt in 5 patients and mean color beam was(2.20±0.84)mm.Residual shunt disappeared in 2 patients at 6 months follow-up.There was no significant alters in left atrial diameter,right atrial diameter or right ventricular anteroposterior diameter in

关 键 词：房间隔瘤 卵圆孔未闭 房间隔缺损 封堵术 

分 类 号：R541.1[医药卫生—心血管疾病]