儿童继发孔型房间隔缺损的介入治疗  

Transcatheter closure of secundum atrial septal defect in children

作　　者：高伟[1] 周爱卿[1] 余志庆[1] 李奋[1] 张玉奇[1] 孙锟[1] 钟玉敏[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心心内科,200127

出　　处：《中华儿科杂志》2004年第4期287-290,共4页Chinese Journal of Pediatrics

摘　　要：目的　探讨儿童继发孔型房间隔缺损 (atrialseptaldefect ,ASD)封堵术的指征、方法学和并发症的预防。方法　 1998年 10月～ 2 0 0 3年 1月 ,119例继发孔型ASD患儿 ,根据家属意愿接受了经导管应用Amplatzer房间隔封堵器的介入治疗。年龄 0 8～ 17 0岁 ,平均 ( 7 5± 2 8)岁 ,体重6 7～ 88.0kg ,平均 ( 2 3 7± 7 8)kg。所有病例术前检查被证实均为继发孔型ASD。按ASD球囊伸展直径或大于 1～ 2mm选择封堵器进行堵塞。其中 3例为多发ASD。 6例合并动脉导管未闭 ( patentductusarteriosus,PDA)或肺动脉瓣狭窄 ( pulmonarystenosis ,PS)者应用其他封堵装置和球囊扩张治疗合并的畸形。术后定期行心脏超声及临床检查随访。结果　 119例患儿术前经食道超声(transesophagealechocardiography ,TEE)或经胸超声 (trans thoracicechocardiography ,TTE)检测ASD平均直径 ( 12 9± 5 6 )mm ( 6 5～ 34 5mm ) ,肺动脉平均压力为 ( 2 9 0± 5 0 )mmHg( 2 5 0～ 6 2 0mmHg) ,球囊伸展直径为 ( 15 7± 4 8)mm( 8 0～ 38 0mm)。所选封堵器直径平均为 ( 15 0± 5 0 )mm( 8 0～ 38 0mm)。 112例封堵成功。 3例多发ASD也选用单一封堵器。 6例合并PDA或PS者同时完成介入治疗。 112例堵塞后即刻封堵率为 93 8% (Objective This study was undertaken to investigate the indication, methodology and complication of transcatheter closure of secundum atrial septal defect (ASD) ASD transcatheter occlusion techniques have become alternative to surgical procedures A number of different devices are available for transcatheter ASD closure The type and incidence of complications depend partially upon different devices Methods A retrospective analysis was performed on the patients treated from October 1998 to January 2003 Transcatheter closure of ASD with Amplatzer septal occluder (ASO) was performed in 119 patients, of whom 3 patients were multiple ASD, 3 associated with pulmonary stenosis (PS) and 3 patent ductus arteriosus (PDA) The age of the cases ranged from 0 8 to 17 years (mean 7 5±2 8 years) and the body weight ranged from 6 7 to 88 kg (mean 23 7±7 8 kg) They all met with criteria for transcatheter closure The balloon stretched diameter of ASD was determined with fluoroscopy, ultrasound and measuring plate A choice of device size was identical to or 1～ 2 mm larger than the stretched diameter (SD) A simultaneous PDA closure with device or balloon dilation was done in six cases associated with PDA or PS, respectively Follow up was performed based on the echocardiographic and clinical findings Results In 119 cases examined with transesophageal echocardiography (TEE) or trans thoracic echocardiography (TTE), ASD mean diameter was (12 9±5 6) mm (6 5-34 5 mm), pulmonary mean pressure was (29 0±5 0) mmHg (25 0-62 0 mmHg), and SD was (15 7±4 8) mm (8 0-38 0 mm) The diameters of these devices were (15 0±5 0) mm (8-38 mm) The devices were successfully implanted in 112 cases Of them, 3 patients had multiple ASD with one device occlusion 6 cases associated with PDA or PS were treated successfully with PDA occlusion or balloon dilatation, respectively The immediate, one month and one year complete occlusion rates were 93 8%(105/112), 97 3%(109/112) and 98 2%(110/1

关 键 词：儿童 继发性孔型房间隔缺损 介入治疗 封堵术 手术指征 预防 

分 类 号：R725.4[医药卫生—儿科]