超声心动图在应用Amplatzer封堵器关闭儿童房间隔缺损中的应用价值

目的　评价经胸超声心动图 (TTE)和经食管超声心动图 (TEE)在应用Amplatzer封堵器关闭儿童房间隔缺损(ASD)中的应用价值。方法　对 12例拟诊为继发孔型ASD的儿童 (年龄 2～ 13岁 ) ,应用Amplatzer封堵器经导管关闭ASD。通过TTE和 (或 )TEE在术前显示ASD大小及其边缘的解剖特点 ,术中指导封堵器的放置 ,术后评价疗效。结果　 (1) 12例中 ,TEE排除ASD诊断 1例 ,诊断为下腔型ASD和显示缺损前上缘薄弱者各 1例 ,这 3例未实施封堵术。 (2 )TEE测量ASD大小 (5～ 2 6mm ,平均 13 6mm) ,与ASD伸展径 (7～ 30mm ,平均 16 6mm)具有高度相关性 (r=0 994 ,P <0 0 1) ;与术前TTE测量ASD大小很接近 (5～ 2 1mm ,平均 14 3mm) ,后者与ASD伸展径亦具有高度相关性 (r =0 932 ,P <0 0 1)。 (3) 9例实施封堵术者 ,有 8例封堵成功 ;1例在封堵器释放后 15min发生脱落 ,改为外科修补。 (4) 8例成功实施封堵术者经TTE随访 1～ 2 2个月 ,无残余分流征象。结论　应用Amplatzer封堵器经导管关闭ASD可取得良好效果 ;超声心动图在经导管关闭ASD过程中具有重要价值 ,TTE和TEE各具优点 ,TTE适用于病例的初步筛选和术后随访 ;而TEE则在决定是否进行封堵术和指导封堵器的正确放置等方面发挥重要的作用。     

Predictors of Successful Transcatheter Closure of Atrial Septal Defect by Cardiac Magnetic Resonance Imaging

The location, size, and rim of an atrial septal defect (ASD) are major determining factors for transcatheter closure. We compared the measurements of ASD size and the characteristics of atrial septal rim using cardiac magnetic resonance imaging (MRI) with those obtained using transesophageal echocardiography (TEE). Patients with an ASD that met established criteria were selected for evaluation by cardiac MRI and TEE. There were 66 patients who underwent both TEE and cardiac MRI. Bland–Altman comparative analysis was performed to demonstrate agreement between measurement of ASD by MRI and balloon sizing compared to measurement of ASD by TEE and balloon sizing. Twelve patients were excluded from transcatheter closure of ASD. TEE did not demonstrate an adequate measurement of the posterior inferior rim in 10 of 66 patients. Fifty-four patients underwent transcatheter closure using the Amplatzer septal occluder. Of these, 52 patients had successful closure (ASD measurements of 25.9 ± 5.6 mm using MRI and 21.9 ± 5.8 mm using TEE). The median device size was 28 mm (range, 11–38). Patients who had successful closure had a significantly smaller major axis of ASD and larger posterior inferior rim compared to those of patients who were excluded from the closure procedure. Cardiac MRI showed a better correlation of ASD diameter measurement to balloon sizing compared to TEE. We believe that the most important predictive factor for successful transcatheter closure of an ASD is an adequate posterior inferior rim, which is best visualized using cardiac MRI.     

Combined Treatment for Multiple Cardiac Defects with Interventional Techniques

Multiple congenital cardiac defects are usually addressed by cardiac surgery. We present our experience with simultaneous transcatheter treatment of multiple defects in children. Ten children, six females and four males, with multiple defects underwent treatment with interventional technique. The mean age was 4.4 +/- 2.6 years (range, 7 months to 8 years). The cardiac diagnosis was patent ductus arteriosus (PDA) and valvular pulmonary stenosis (PS) in two, atrial septal defect (ASD) and PDA in two, ASD and PS in two, PDA and aortic stenosis (AS) in three (severe left ventricular dysfunction in two), and perimembranous ventricular septal defect (VSD) and valvular PS in one. The ASDs were closed with an Amplatzer septal occluder (mean size, 16 +/- 4 mm), four PDAs were closed with an Amplatzer duct occluder, and three with a Cook's detectable coil. Mean balloon size used to dilate the pulmonary valve was 18 +/- 4 mm, and for the aortic valve this was 12 +/- 2 mm. There was a 70% (+/-15%) postprocedure reduction of gradients across the stenotic valves. The closure rate was 75% for PDAs in the catheterization laboratory, 80% for ASDs, and there was a mild residual intradevice leak in the VSD. In conclusion, interventional technology addressing multiple congenital cardiac defects as a combined procedure in the catheterization laboratory is safe and effective.     

Comparison of Atrial Septal Defect Closure Using Amplatzer Septal Occluder with Surgery

Our study reports the results of a comparison of closure of atrial septal defect (ASD) surgically with transcatheter closure using the Amplatzer septal occluder. Patients having an ASD and a surgical closure or transcatheter closure between January 1999 and July 2000 were selected. There were 103 patients who had ASD. All 64 patients in group 1 (surgery) had a successful operation, with only 2 patients with a mild residual shunt. There were 39 patients enrolled for transcatheter closure of the ASD (group 2). Four patients were excluded initially. The median age for group 1 was 25 years (range 2.3-64 years) compared to 11.7 years (range 2-69 years) in group 2 (p = 0.035). In group 1, the mean ASD diameter measured was 28.4 +/- 10.2 mm compared to 23.4 +/- 5.7 mm in group 2 (p = 0.003). In 29 patients, devices were deployed with sizes from 10 mm to 30 mm (median 24 mm). Three patients were excluded because a larger device (>30 mm) was not available and devices were not successfully deployed in another 3 patients. One patient had a device embolized into the right ventricle (surgical removal and closure of the ASD). Complications occurred in 13 patients in group 1 and 4 patients in group 2. Complete occlusion occurred in 27 of 28 group 2 patients (96.4%) during the follow-up period (10.2 +/- 5.4 months). The Amplatzer septal occluder is a new device for closure of different-sized ASDs. The intermediate-term follow-up demonstrated excellent closure results. The benefit for each patient was demonstrated in less morbidity and less time spent in the hospital.     

Measurement of Atrial Septal Defect Size: A Comparative Study Between Three-Dimensional Transesophageal Echocardiography and the Standard Balloon Sizing Methods

Atrial septal defect (ASD) size measurement is of paramount importance for the successful deployment of a transcatheter septal occluder. The stretched balloon diameter (SBD) has long been regarded as the gold standard for selection of the size of any device. Three-dimensional (3-D) transesophageal echocardiography (TEE) can visualize the overall structure of the atrial septum, therefore rendering an accurate size of the ASD. In this study we aimed to validate the accuracy of ASD size measurement by 3-D TEE and to elucidate the reason for the difference between balloon sizing and 3-D measurement. Forty-one consecutive patients were enrolled in this protocol for ASD device closure using the Amplatzer septal occluder. Thirty-nine patients were diagnosed by 2-D transthoracic echocardiography as secundum ASD and 2 patients were diagnosed as patent foramen ovale. Two measurements of the balloon size were sequentially obtained by 2-D TEE after the balloon was fully inflated in the left atrium. First, no residual shunt across the septum could be seen while the balloon was pulled back against the septum. This measurement was called the balloon occlusive diameter (BOD). Second, with balloon deflation, a slight deformity of the balloon was seen just prior to its popping through the septum. This measurement was called the stretched balloon diameter (SBD). Three-dimensional TEE was performed in all patients at the beginning of the procedure before device deployment and within 15 minutes after device release. Three-dimensional TEE provided superior views of the ASDs, showing the spatial relationship between the ASD and the neighboring structures. For maximal ASD size measurement, balloon sizing was larger than 3-D TEE examination, whereas 2-D was smaller than the other two methods. The best correlation was found between 3-D TEE measurements and the BOD (r= 0.98, p < 0.0001). Three-dimensional TEE provides en face view of ASD; thus, it can accurately measure the size of ASD. Three-dimensional TEE measurement of ASD can be used instead of balloon sizing for the selection of transcatheter ASD occluder size.     

儿童继发孔型房间隔缺损的介入治疗

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% ( 1     

Helex Septal Occluder: Feasibility Study of Closure of Atrial Septal Defect

Background A variety of transcatheter atrial septal defect (ASD) occluders are currently in use, the most commonly used device is the Amplatzer Septal Occluder (ASO) yet there is no perfect device. The Helex Septal Occluder is a new device (by W.L. Gore & Associates, Inc.) designed to improve the results of transcatheter ASD closure. We report our first experience in closing secundum ASDs with this new device after its recent modifications. Methods Thirteen patients were selected for Helex device closure with median age of 8 years (2.5–44 years) and median weight 30 Kg (12–96 Kg). Inclusion criteria were: small to moderate Secundum ASDs with sufficient rims by transthoracic echo (TTE) and confirmed by transoesophageal echo (TEE). Two cardiologists carried out the decision of device size. One of the five available Helex ASD device sizes was used (15–35 mm). Follow up TTE was performed the next day, one month, six months and one year later. Results Twelve patients had successful Helex septal occluder implantation. One patient was switched to Cribriform ASD device during the procedure because of failure of the locking mechanism. Two patients had trivial residual left to right shunt which disappeared at one month follow up in one patient. No embolic event, AV block or mortality was observed. Conclusion This feasibility study of the novel Helex septal occluder after its recent modification showed that it can successfully and safely close well selected secundum ASDs. There are several advantages over the currently available devices.     

小儿房间隔缺损介入治疗40例临床报告

目的 评价小儿继发孔型房间隔缺损(ASD)应用美国AGA公司的Amplatzer封堵器介入治疗的临床疗效。方法 Ⅱ孔型ASD40例。男16例,女24例;年龄3～15岁,平均10．2岁。体重11～87kg,平均35．8kg.6例合并肺动脉瓣狭窄(PS),1例合并二尖瓣脱垂和轻度关闭不全,l例台并室性心动过速(VT)。40例均采用美国AGA公司的AmplatzerASD封堵器。术中常规行右心导管检查,测量右室、肺动脉压力。经导引钢丝导人球囊导管测ASD最大伸展直径。用体表经胸超声心动图(TTE)或食道超声(TEE)测量房间隔直径及确定ASD的位置及大小。根据球囊最大伸展直径选择等于或大于l～2mm型号的ASD封堵器。结果 40例患儿应用40个Amplatzer封堵器封堵成功,成功率100%。经TTE测量ASD直径为7～30mm(平均17．12mm),TEE测量直径为7～32mm(平均18．44mm)。最大球囊伸展直径为8～34mm(平均20．56mm)。Amplatzer封堵器型号8～38mm(平均21．44mm)。合并PS,先行球囊扩张术,成功后再封堵ASD。合并VT先行射频消融术而后成功封堵ASD.40例无并发症,无残余分流。术后3—4天出院。术后3d复查ECG、TTE及X线胸部检查有明显改善。结论 AmplatzerASD封堵器封堵小儿ASD是安全、有效的。规范化治疗。严格掌握适应证是成功的保证。     

165例5岁以下小儿房间隔缺损的介入治疗

目的总结双盘封堵器(Amplatzer)关闭年龄小、体重轻患儿的继发孔型房间隔缺损(ASD)的病例。方法1998年8月至2004年5月,165例5岁和18kg以下小年龄组继发孔型ASD病例接受Amplatzer封堵器介入治疗。所有患儿均经临床体检、X线胸片、心电图、经胸超声心动图(TTE)确诊为继发孔型ASD。TTE观察和测量ASD和房间隔(IAS)最大径,测量球囊导管测量ASD最大伸展径,必要时加用食道超声(TEE)测定,筛选后的患儿依此选择封堵器。结果163例成功封堵ASD,成功率98.8%。本组ASD最大径(8～30)mm,平均(18.3±5.1)mm,选择封堵器直径(8～30)mm,平均(18.6±5.0)mm,P>0.05。Qp/Qs=3.3±2.0。147例(89.0%)为单纯单孔ASD病例;6例为多孔ASD,其中3例伴有房间隔瘤样改变,均用一个封堵器成功封堵ASD。另外12例合并其他心内畸形,其中6例合并肺动脉瓣狭窄(PS),6例合并动脉导管未闭(PDA)。右心容量超负荷术后明显改善。本组中大ASD占60.0%(100)例。操作上有一定难度。结论Amplatzer封堵器关闭5岁以下儿童房间隔缺损是可行的,但不主张2岁以下行介入治疗。严格掌握适应证;良好的小儿心血管内外科条件是成功封堵的基本保证。     

Experience with use of multiplane transesophageal echocardiography to guide closure of atrial septal defects using the amplatzer device

By providing unlimited imaging planes, multiplane transesophageal echocardiography (MTEE) should improve real-time guidance of interventional procedures. The potential advantages of MTEE in this scenario have not been systematically evaluated. We retrospectively reviewed our experience with MTEE-guided Amplatzer device closure of atrial septal defects (ASDs) MTEE angles used to obtain images for guiding all measurements and maneuvers were recorded. These angles were compared to the range of MTEE angles that are postulated to be available from biplane TEE. Images obtained using MTEE angles from 21° to 70° and from 111° to l59° were defined as only obtainable by MTEE. The MTEE probe was successfully introduced in all (89) patients. Thirteen patients (15%) had multiple defects. Ninety-five devices (5–32 mm in diameter) were deployed. In 66% of patients, balloon sizing and device deployment necessitated imaging planes that are only obtainable by MTEE. All devices were well positioned, with no impingement on inflows or outflows. At follow-up, 79 of 89 (88.7%) patients had no residual ASDs. Each of the remaining 10 patients (11.3%) had a small (<3 mm) residual defect. MTEE played an important role in guiding device closure of ASD, particularly during the phases of balloon sizing and device deployment.     

Percutaneous closure of a mid-muscular residual ventricular septal defect using the Amplatzer(TM) device

We present the case of a 6-year old boy with a mid-muscular residual ventricular septal defect (VSD) of difficult surgical access, who underwent transcatheter closure using the Amplatzer(TM) VSD occluder. Transcatheter closure was guided by transthoracic echocardiography and successful closure was achieved with a 12 mm diameter VSD occluder, with no complications. Chest radiography showed a considerable decrease in cardiomegaly and normalization of pulmonary vascular markings before 24 hours, and echocardiography showed correct positioning of the Amplatzer(TM) VSD device without residual shunt through the device and minimal residual shunt in an apical VSD. After a 3-month follow-up, the patient was asymptomatic and echocardiography showed that the device was correctly positioned with minimal residual apical shunt.     

Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance

Background

This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.

Methods

We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients’ mean age was 60.09?±?36.42 months (13–182 months), and their mean body weight was 20.16?±?10.04 kg (9–77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms.

Results

The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58?±?5.31 mm (3–28 mm), and the mean size of the occlusion device was 16.07?±?5.29 mm (6–36 mm). The mean procedural times were 13.33?±?2.82 minutes (6–16 minutes). The mean hospitalization costs were 27,259.66?±?2507.04 RMB (25,200.00–33,911.45 RMB). The mean postoperative hospital stay was 3.22?±?0.53 days (3–5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation.

Conclusion

Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.

     

Cardiac dysrhythmias after transcatheter closure of ASD with Amplatzer device

Transcatheter closure of atrial septal defect (ASD) has been used as an alternative to open heart surgery. Although transcatheter closure of ASD with the Amplatzer septal occluder is a safe and feasible method in pediatric patients, there is little published data on arrhythmia analysis following transcatheter device closure of secundum ASD. We evaluated cardiac dysrhythmias with 24-hour ambulatory electrocardiographic (ECG) monitoring after transcatheter closure of ASD with Amplatzer device. A total of 85 consecutive patients with ASD underwent transcatheter closure of secundum ASD with Amplatzer device between October 1998 and December 2003. The study involved 65 of these patients assessed by 24-hour ambulatory ECG monitoring. Seven patients were evaluated a second time by 24-hour monitorization. During the procedure, transient complete atrioventricular (AV) block was seen in two patients. One of them returned to normal sinus rhythm in catheterization lab and the other returned to normal sinus rhythm in two hours. Transient junctional rhythm was observed in another patient during the device placement. Twenty-four hour ambulatory ECG monitoring was performed on all patients after a mean four-month period (1-12 months). Holter recordings demonstrated rare supraventricular extrasystole in two patients, rare ventricular premature beats in two patients, and intermittent sinus arrest with sinus pause lasting <1.5 seconds in one patient, for a total of five patients (7.6%). In conclusion, dysrhythmias after transcatheter device closure of secundum ASD with Amplatzer device are rare and benign. We need further long-term follow-up to evaluate late dysrhythmias after the transcatheter device closure of secundum ASD.     

Non surgical closure of atrial septal defect using the Amplatzer septal occluder in children--feasibility and early results

OBJECTIVE: To assess the feasibility and early results of Amplatzer septal occluder in children withy secundim atrial septal defect. SETTING: Tertiary care referral hospital in New Delhi. METHODS: Forty nine children under 12 years of age were diagnosed to be having fossa ovalis atrial septal defect. Forty nine patients underwent detailed 2D-Echocardiography and color Doppler interrogation for the possibility of non-surgical closure of ASD. Sixteen children between age 2.5-12 years (mean 6.5 years) were enrolled into the study. Their weight ranged from 10 kg to 42 kg and there were 9 males and 7 females. The remaining 33 were not considered suitable for device closure in echocardiography and were referred for surgery. RESULTS: All patients had more than 1.8 : 1 shunt. The device was successfully deployed in 13/16 patients. ASD stretched diameter ranged between 13 mm-30 mm (mean 15 mm) and the device size ranged between 14 mm-22 mm. One patient had fenestrated ASD, in this patient the largest of the defect was crossed and closed with 24 mm device resulting in closure of all three defects. We failed in three of our attempts, on one there were deficient inferior margins while in the other two cases the ASD stretched size was such that the device would have encroached upon adjacent structures, hence the procedure was abandoned. All these patients have been operated successfully. Complete abolition of shunt was seen in 38% patients in the immediate post deployment period. At 24 hours complete closure was seen in 12/13 (92%) patients while one patient had trivial residual shunting across the device. This patient also achieved complete closure of atrial shunting when evaluated at three months follow-up. CONCLUSION: Device closure of ASD is emerging as an alternative to surgical closure. However, with the currently available device only a limited number of atrial septal defects can be closed. Long-term studies are required to show sustained benefits and absence of side effects of this device.     

Temporary atrioventricular complete block that develops following the transcatheter closure of ventricular septal defect

Atrioventricular (AV) block is a potential risk after transcatheter closure of perimembranous ventricular septal defect (VSD) with the Amplatzer perimembranous device. We present herein a case of a 6.5-year-old female patient who developed complete AV block six days after closure of VSD and recovered with steroid and salicylate treatment. It is important to be alert to the development of AV block after transcatheter perimembranous VSD closure. Very careful monitoring of rhythm is mandatory during the short- and long-term follow-up.     

Non-surgical closure of atrial septal defect

BACKGROUND: Recently many devices for the transcatheter closure of atrial septal defect (ASD) were developed in the world. Several ASD closing devices, such as Clamshell device, buttoned device, ASD occluder system (ASDOS), Angel Wings, are not fully acceptable from a practical point of view. We reported the clinical trials of transcatheter closure of ASD for Clamshell double umbrella device and Amplatzer septal occluder (ASO) in Japan. METHODS: Clamshell devices were implanted in 11 patients. Clinical trials for ASO device were carried out in 34 patients in Japan. We reported the results of 17 patients in National Children's Hospital. RESULTS: Clamshell devices were implanted in all of the patients successfully. Minimal residual shunt was present in four patients (36%), 1 year after the procedure by Doppler color flow imaging. Nine of 11 umbrellas demonstrated fracture of the stainless steel arm. Arm fracture occurred between 1 week and 12 months after implantation. The implantations of ASO device were successful in all of the 17 patients. Sixteen out of 17 (94.1%) had complete closure in the average observation period of 5.5 months. Complications were minimal and transient. CONCLUSIONS: With respect to complete closure rate, easy manipulation, and complication rate, ASO is the best transcatheter ASD closure device among all the devices at the present time.     

Device closure of congenital ventricular septal defects with Amplatzer devices: first experiences in Turkey

Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional method. The success depends on the precise anatomic definition of the defect and its relation to other cardiac structures. We report our first experiences of transcatheter closure of perimembranous and muscular VSD. Between May 2005 and September 2006, transcatheter closure of VSD was attempted in 38 patients. Implantation was successful in 37 patients. In one patient, the procedure failed because of the long sheath kinking. We observed important complications in three patients: severe tricuspid valve regurgitation, residual VSD and tricuspid valve regurgitation and right bundle branch block in the short-term follow-up. Transcatheter device closure with Amplatzer device seems to be effective and safe in the treatment of perimembranous and muscular VSDs. Tricuspid valve incompetence may cause problems. Long-term results are required to determine the efficacy and safety.     

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目的探讨经胸超声心动图(TTE)及实时三维超声心动图在房间隔缺损(ASD)、室间隔缺损(VSD)封堵术中的临床应用价值。方法应用二维及三维超声心动图对2004-10—2005-10在天津市儿童医院就诊的24例继发孔ASD,10例VSD进行术前检查筛选,术中超声引导及术后随访检查。结果24例ASD患儿术前经TTE检测ASD直径(15·6±7·9)mm(5~26mm),所选Mmplatzer封堵器直径为(19·1±5·1)mm(5~32mm),23例封堵成功。室间隔膜部缺损直径:左室面缺损为5~9mm,右室侧口的直径为2·4~6·0mm,术中选择Amplatzer封堵器型号为4~6mm,10例VSD无残余分流。结论二维及三维TTE联合应用于ASD、VSD介入治疗具有很好的应用价值。     

先天性心脏病术后残余室间隔缺损介入治疗及中长期随访

目的 评价先天性心脏病（先心病）术后残余室间隔缺损（VSD）介入治疗的效果及中长期随访结果。 方法 回顾性分析2002年9月至2014年5月复旦大学附属儿科医院介入治疗的先心病术后残余VSD患者的临床资料,对辅助检查、介入治疗情况和随访行描述性分析。结果 21例患者进入分析,男11例,女10例,平均年龄8.8（2.7～21）岁,平均体重26.3（10.5～53.5） kg。13例为VSD修补术后残余漏,其中2例合并主动脉弓缩窄修补术后再缩窄;5例为法洛四联症（TOF）术后残余VSD,其中1例合并频发室性早搏及短阵室性心动过速;2例为右室双出口术后残余VSD;1例为完全性大动脉转位术后残余VSD。介入治疗距离外科手术时间为11～80个月。①介入治疗中左心室造影测得VSD右心室面直径为(3.73±1.56) mm,4例右室面有多处分流,1例为左室-右房瘘;肺循环与体循环血流量之比为1.53±0.23;无中度以上肺动脉高压者。②21例患者中,1例介入治疗中建立轨道时反复发生Ⅲ度房室传导阻滞而放弃堵闭行外科手术治疗;20例（95.2%）封堵成功,其中1例应用2个堵闭器。1例合并频发室性早搏及短阵室性心动过速患儿同时行射频消融治疗成功;2例合并主动脉弓再缩窄患儿经球囊扩张后缩窄解除。介入治疗中无不良事件发生。介入治疗后即刻造影和经胸超声心动图显示少量残余分流3例。ECG均无异常发现。③20例随访1～79个月,均无明显临床症状。2例在1年随访中ECG分别出现不完全性右束支传导阻滞及Ⅰ度房室传导阻滞,继续随访6~12个月无改变;2/3例即刻有残余分流患儿在随访中残余分流消失,1例介入治疗后20个月时仍有残余分流3.4 mm,心腔大小和功能正常;无新发的三尖瓣或主动脉瓣反流,3例堵闭前存在的中重度三尖瓣反流在随访中反流均为轻度;未见堵闭器移位、脱落或血栓形成。结论 经导管堵闭介入治疗先心病手术后残余VSD是一项安全、有效和易行的方法,介入治疗后即刻和中长期随访效果好,应成为此类患儿首选的治疗方法。     

Quantitative evaluation of the changes in plasma concentrations of cardiac natriuretic peptide before and after transcatheter closure of atrial septal defect

The purpose of this study was to investigate the changes in plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with atrial septal defect (ASD) during transcatheter closure of defects. The plasma concentrations of ANP and BNP were obtained from 14 patients with ASD at before closure, and at 5 min, 24 h, 1 mo and 3 mo after transcatheter ASD closure using an Amplatzer septal occluder. Ten healthy children aged 6-18 y were studied as controls. All ASDs were successfully closed. Compared with control values (mean +/- SD, 17 +/- 6.8 ng 1(-1), ANP concentrations before closure were significantly elevated (24 +/- 9.8ng 1(-1), p < 0.05). ANP concentrations increased significantly at 5 min after closure (34 +/- 18 ng 1(-1), p < 0.05) compared with preclosure concentrations. At 24 h after closure, the concentrations decreased to values not different from control values (19 +/- 11 ng 1(-1), p = ns). BNP levels before closure (19 +/- 9.9 ng 1(-1) were also elevated significantly compared with control values (12 +/- 4.9ng 1(-1), p < 0.05). BNP concentrations increased significantly at 5 min after closure (23 +/- 14 ng 1(-1), p < 0.05) compared with preclosure concentrations. ANP values at 24 h were lower than at 5 min after closure, whereas BNP values were higher (32 +/- 11 ng 1(-1), p < 0.05). As with ANP, the concentrations gradually decreased to values not different from control values at 3 mo after the procedure (12 +/- 6.3 ng 1(-1), p = ns). CONCLUSION: Plasma concentrations of ANP and BNP may become effective markers for evaluating changes in cardiac load after transcatheter ASD closure.