房间隔缺损封堵器在卵圆孔未闭合并房间隔瘤中的有效性及安全性研究  

Efficacy and safety of atrial septal defect occluder in patent foramen ovale complicated with atrial septal aneurysm

作　　者：官政燕 郑璐璐 方晗[2] 孙泽琳[2] 裴志芳[2] 刘凤姣 邹隽麟 吴婷婷 钟旭[2] 陈晓彬[1] GUAN Zheng-yan;ZHENG Lu-lu;FANG Han;SUN Ze-lin;PEI Zhi-fang;LIU Feng-jiao;ZOU Jun-lin;WU Ting-ting;ZHONG Xu;CHEN Xiao-bin(Department of Cardiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院心内科,湖南长沙410008 [2]中南大学湘雅医院心脏超声室,湖南长沙410008

出　　处：《中国介入心脏病学杂志》2022年第8期590-595,共6页Chinese Journal of Interventional Cardiology

基　　金：湖南省自然科学基金项目(S2021JJMSXM1714)。

摘　　要：目的 比较Cardi-O-fix卵圆孔未闭(PFO)封堵器和国产房间隔缺损封堵器(ASDO治疗PFO合并房间隔瘤(ASA)的有效性及安全性。方法 回顾性分析2019年1月至2020年12月在中南大学湘雅医院心内科行经导管介入封堵治疗的70例PFO合并ASA患者,根据PFO解剖结构特点选用Cardi-O-fix PFO封堵器(COF组,共38例)或ASDO(ASDO组,共32例)行介入封堵术,术后随访12个月,比较不同封堵器的有效封堵率、残余分流、并发症发生率等指标。结果 ASDO组封堵器腰部直径(即PFO的大小)为(9.57±2.72)mm。COF组患者ASA基底部直径小于ASDO组,差异有统计学意义[经食管超声心动图:(21.46±4.87)mm比(25.09±3.68)mm,P<0.001;经胸超声心动图:(22.14±5.14)mm比(24.88±3.42)mm,P=0.010)]。随访12个月,两组患者均未发生复发性卒中或死亡事件,术后1个月、3个月、6个月和12个月的有效封堵率和残余分流率分别比较,差异均无统计学意义(均P>0.05)。两组均未发生心房颤动、心房扑动、动静脉瘘、假性动脉瘤、心包积液、心脏压塞、封堵器移位脱落等并发症。结论 对于PFO合并ASA的患者,ASDO疗效不劣于PFO封堵器。PFO合并ASA时往往PFO较大,对于基底部较小的患者,常规PFO封堵器能覆盖ASA左心房面时,建议首选常规PFO封堵器;对于ASA基底部较大的患者,常规PFO封堵器可能无法完全覆盖固定ASA,建议使用小腰大边型ASDO。Objective To compare the efficacy and safety of Cardi-O-fix PFO occluder and domestic atrial septal defect occluder(ASDO)in the treatment of patent foramen ovale(PFO)with atrial septal aneurysm(ASA).Methods A total of 70 patients with PFO combined with ASA were retrospectively enrolled from January 2019 to December 2020 in our hospital.Transcatheter closure of PFO was applied according to the anatomical structure of the disease.Cardi-O-fix PFO occluder was used in 38 cases(COF group)and ASDO was used in 32 cases(ASDO group).The rate of effective PFO closure,residual shunt and complications of the two devices were compared during the 12 months follow-up.Results The waist diameter of the occluder in the ASDO group(the size of the PFO)was(9.57±2.72)mm.The ASA basal size in COF group was significantly smaller than in ASDO group[(21.46±4.87)mm vs.(25.09±3.68)mm,P<0.001 by TEE;(22.14±5.14)mm vs.(24.88±3.42)mm,P=0.010 by TTE].After 12 months of follow up,there was no recurrent stroke or death in the two groups.The effective occlusion rate and the residual shunt rate in the first,third,sixth and twelfth months after operation were similar between COF group and ASDO group(all P>0.05).There were no complications such as atrial fibrillation,atrial flutter,arteriovenous fistula,pseudoaneurysm,pericardial effusion,pericardial tamponade,and displacement of occluder in both groups.Conclusions For patients with PFO complicated with ASA,the effect of ASDO is not inferior to that of PFO occluder.PFO tends to be larger in the presence of ASA.For patients with a small ASA basal size and the left atrial surface of the ASA can be completely covered by a PFO occluder,it is recommended to choose the PFO occluder;for patients with a large ASA basal size and the ASA may not be fully covered by a PFO occluder,a small waist and large disk ASDO may be an option.

关 键 词：卵圆孔未闭 房间隔瘤 经导管封堵术 残余分流 并发症 

分 类 号：R541[医药卫生—心血管疾病]