Amplatzer封堵器治疗房间隔缺损的方法学研究和临床疗效评价

目的　采用数字影像测量球囊直径指导Amplatzer封堵器植入 ,评价这一方法的可靠性及近期临床疗效。 方法　 30例病人 ,经胸壁超声心动图 (TTE)检查证实为先天性心脏病房间隔缺损 (ASD)。在X线透视及经食管超声心动图监视下 ,采用数字影像测量球囊直径指导选用适宜直径的Amplatzer封堵器封堵ASD。术后 3天、3个月及 1年分别行经胸超声心动图 (TTE)、心电图及X线检查评价治疗效果。结果　 30例ASD术中TEE测定直径、球囊伸展直径和封堵器直径分别为 10 30mm [(2 0 .3± 5 .0 )mm]、10 34mm[(2 1.8± 6 .1)mm]和 12 38mm [(2 4 .8± 6 .4 )mm]。 30枚封堵器植入均获得成功 ,一次封堵成功率 85 %。 30例均完成 3个月随访 ,TTE显示ASD完全闭合 ,右心房、心室缩小 ;其中 2 0例完成术后 1年随访 ,未见残余分流及再通。结论　用数字影像测量球囊直径指导Amplatzer封堵器植入治疗ASD是一种简单可靠方法     

经食道心脏超声对应用Amplatzer封堵器治疗房间隔缺损的观察

目的 :观察应用Amplatzer封堵器经导管治疗二孔型ASD的疗效 ,并评价经食道超声 (TEE)在介入治疗ASD中的价值。方法 :全组共 1 8例 ,均为二孔型ASD ,年龄 1 4～ 4 1岁 ,平均 2 1 .6岁。TEE测ASD最大直径 3 3mm ,平均 2 1 .4mm ,缺损周边有足够的房间隔空间。在透视及TEE监视下经导管置入Amplatrzer封堵器封堵ASD ,术后即刻、2 4h、3个月分别行TEE检查 ,评价治疗效果。结果 :全组技术成功率为 1 0 0 % ,术后 2 4hTEE检查显示 1 4例ASD完全闭合 ,4例存在微量残余分流 ,术后 3个月均无残余分流 ,无任何并发症。结论 :应用Amplatzer封堵器经导管治疗二孔型ASD操作简便 ,成功率高 ,是目前导管介入治疗ASD的首选治疗器材。TEE在对病例的筛选、引导封堵器的置入及术后疗效评价等方面有极重要的作用。     

国产封堵器介入治疗房间隔缺损的疗效及安全性

目的 评价应用国产房间隔封堵器治疗房间隔缺损的疗效及安全性。方法 12例房间隔缺损患者，男性4例，女性8例，年龄18-45岁。对患者均使用经体表超声心动图（TTE）监测。封堵器选用国产房间隔封堵器（北京华圣杰科技有限公司研制）。房间隔缺损封堵术后48h进行TTE复查，术后1、3、6个月随访得查心电图、TTE、X线，并观察疗效及安全性。结果 11例封堵手术成功，即刻手术成功率91.67%，术中及术后48hTTE星移斗转测均无残余分流。术后1、3、6个月随访，原有临床不适症状缓解，TTE显示封堵器位置稳定，房间隔水平无分流。结论 国产房间隔封堵器对房间隔缺损进行介入治疗，临床使用有效、安全。     

房间隔缺损介入治疗的护理

房间隔缺损(artrial septal defects，ASD)是一种常见的先天性心脏病，既往外科手术是其唯一的治疗方法。1974年King等首先应用介入治疗技术闭合继发孔型ASD。此后，经导管介入性治疗ASD得到迅速发展，并取得良好的临床治疗效果。其中，护理在ASD介入治疗中有着重要的意义，对治疗疗效有着至关重要的作用。本文结合我科自1998年1月至2003年12月70例应用Amplatzer封堵器治疗继发孔型ASD患者，探讨ASD介入治疗中的护理，以取得良好的疗效。     

超声心动图在常见先天性心脏病Amplatzer封堵术中的应用

目的:探讨超声心动图在常见先天性心脏病封堵术中的应用价值.方法:本组先天性心脏病47例中,ASD 31例、PDA 7例及VSD 9例,经胸或/和经食道超声心动图检查符合条件而行经导管以Amplatzer封堵器封堵术治疗.结果:47例中,除2例患者因双孔或单孔ASD最大伸展径较大(＞34 mm)而放弃封堵外,余45例患者在超声指导下以Amplatzer封堵器封堵成功,均无残余分流,成功率为95.75%(45/47).结论:采用Amplatzer封堵器封堵治疗常见先天性心脏病时,超声心动图对于术前病例选择、术中指导监测、封堵器型号的选择以及术后疗效评价等,均有较大的临床价值.     

经胸骨下段小切口行室间隔封堵85例临床分析

目的评价经胸骨下段小切口封堵器治疗室间隔缺损(ventricular septal defect ,VSD)的疗效及优点。方法2009年1月~2012年8月，采用Amplatzer VSD封堵器对85例VSD进行封堵治疗。男38例，女47例，体重9.5~72kg，(42.3±16.5)kg，经胸超声心动图显示为膜周部VSD，破口3~10.5mm，全麻下经胸骨下段切口经右室放置封堵器。出院前和术后1个月、3个月，6个月、12个月进行径胸超声心动图、心电图、X线胸片等检查。结果82例成功进行封堵，3例失败。术后气管带管时间2.3~16h(6.0±2.3)，ICU滞留时间8~17h(14.1±3.2)。引流量30~190ml(70±28)。82例随访8~15个月(8.3±5.1)月，无主动脉瓣关闭不全，无传导阻滞，无封堵器移位，脱落，无血栓形成，无血红蛋白尿。2例术后发现有残余分流的1~2mm。结论往胸骨下段小切口行VSD封堵疗效良好。     

国产封堵器闭合房间隔缺损后心功能和心电图改变

目的探讨应用国产封堵器闭合房间隔缺损(ASD)术后心功能及心电图改变。方法继发型ASD患者36例,其中男性10例,女性26例,年龄(26.11±15.41)岁,平均缺口大小(23.65±7.83)mm。应用深圳先健公司ASD封堵器治疗,封堵器直径(27.91±8.11)mm。术前及术后3、6个月行经胸超声心动图(TTE)及同步12导联心电图(ECG)检查。结果①堵闭术后3、6个月,左心室舒张末期前后径(LVED)、左心室收缩末期前后径(LVSD)、左心室舒张末期容积(LVEDD)、左心室收缩末期容积(LVESD)及左心室每搏量(LVSV)较术前明显增加(P均<0.01),右心室舒张末期前后径(RVED)、右流出道内径(RVOTD)较术前明显缩小(P均<0.01)。②与术前比较,术后6个月心率(HR)明显减慢(P<0.01),PR间期明显缩短(P<0.05),右心室高电压(RVH)及右束支阻滞(RBBB)的发生率明显减少(P均<0.05)。结论国产封堵器ASD封堵术后3个月起左心室收缩及舒张功能明显改善;术后6个月心率减慢,PR间期明显缩短,RVH及RBBB发生率明显减少。     

经胸超声在Amplatzer封堵器介入治疗先天性房室间隔缺损中的临床应用

目的探讨经胸超声在AmpLatzer封堵器介入治疗先天性房间隔缺损、室间隔缺损中的临床应用价值。方法术前应用经胸超声筛选封堵术适应证36例先心病,其中26例房间隔缺损、10例室间隔缺损。术中用经胸超声监测指导释放封堵器,即刻观察疗效。于胸骨旁四腔观、房间隔短轴观、心尖四腔观、心尖五腔观、大动脉短轴观、剑突下四腔心观分别观察封堵器的形态,瓣膜反流及封堵器周围分流情况。术后进行定期复查。结果26例房间隔缺损、10例室间隔缺损封堵成功,总成功率100%。其中16例出现二、三尖瓣反流或残余分流,经调整封堵器的位置和方向后,10例反流即刻消失,6例术后1个月消失。结论经胸超声可用来筛选房间隔缺损、室间隔缺损封堵术病例,术中指导Amplatzer封堵器定位和释放,疗效评估和预后评价方面有不可替代的临床应用价值。     

54例超声心动图引导下先天性心脏病封堵治疗回顾分析

目的 探讨超声引导下房间隔缺损(ASD)和室间隔缺损(VSD)封堵的方法、疗效等临床经验。方法 2010年12月至2019年9月,54例先天性心脏病患者行超声心动图引导下介入封堵手术,其中房间隔缺损30例,室间隔缺损24例。14例ASD采取胸骨右缘第4肋间小切口,经右心房途径封堵;16例ASD通过股静脉穿刺,经血管内途径封堵。24例VSD经剑突下小切口右室前壁途径封堵。结果 经胸封堵24例VSD,均顺利。经胸封堵ASD中,有1例在术后7 h发生封堵器移位,紧急开胸在体外循环直视下取出封堵器,修补ASD。16例经股静脉途径封堵ASD中,手术顺利13例,封堵失败3例,封堵失败后改经胸小切口封堵2例,改体外循环下直视手术1例。46例随访3～103个月,平均(21.3±16.2)个月,未见封堵器移位、脱落、明显残余分流以及其他并发症发生。结论 超声引导下经股静脉途径或经胸小切口房间隔缺损及室间隔缺损封堵安全有效,无射线辐射,操作简单易普及。     

经胸超声心动描记术在房间隔缺损封堵中的作用

目的探讨超声心动描记术在房间隔缺损（ASD）封堵术术前诊断筛选、术中监测指导、术后随访评价中的作用。方法 11例中央型ASD患者,其中男性4例,女性7例;年龄4～65岁,平均年龄29岁。术前应用彩色多普勒超声心动描记术经胸观察、测量ASD大小、位置及与周围组织结构的关系,并观察周缘软硬情况,选择封堵器型号。术中监测封堵过程、观察封堵器的牢固性,彩色多普勒观察有无残余分流,术后进行随访。结果术前检查ASD大小5～34mm,术中选用的封堵器大小8～38mm,所有患者手术顺利完成,无并发症发生,经3个月以上的随访,封堵器固定牢固,无脱落,无残余分流。结论超声心动描记术在ASD封堵术术前诊断筛选、术中监测指导、术后随访评价中发挥了重要作用。     

小儿先天性心脏病介入治疗手术73例临床分析

目的评价介入治疗手术在小儿先天性心脏病治疗中的价值。方法总结我院近五年来73例经导管介入治疗的先天性心脏病患儿。其中动脉导管未闭（PDA）35例,继发孔房间隔缺损（ASD）30例,室间隔缺损（VSD）5例,肺动脉辨狭窄（PS）3例。应用AGA Amplatzer封堵器、国产封堵器及球囊扩张导管。结果成功率为100％,术后随访3月-2年,无不良并发症。结论经导管介入治疗小儿先天性心脏病安全,有效,创伤小,操作简单,住院时间短,是一项有发展前景的治疗方法。     

Emergency surgical approach to device emboli due to migration of the atrial septal defect occluder

Introduction

Atrial septal defect (ASD) transcatheter occlusion techniques are now established as the preferred method and have become an alternative to surgery under extracorporeal circulation. In this study, we aimed to present our emergency surgical approach to cases of device embolization due to migration of the atrial septal defect occluder.

Material and methods

Between June 2009 and June 2011, 6 patients underwent emergency operations due to device emboli secondary to migration of the transcatheter atrial septal defect occluder during the early period. Mean age was 25.5 years (15–45) and 3 of the patients were female (50%). The diagnosis was made via transthoracic echocardiography (TTE) preoperatively.

Results

All of these 6 patients underwent emergency operations. Mean postoperative intensive care unit (ICU) stay was 2.2 days and mean hospital stay was 6 days. No early or late postoperative mortality was seen. Mean postoperative follow-up time was 19.3 months (range: 5–28 months). Early- and late-period TTE examinations showed no residual interatrial shunting. One patient developed a right atrial thrombus in the postoperative 22^nd month as a complication of long-term follow-up. He was treated with anticoagulant therapy for 6 months with complete resolution at the TTE.

Conclusions

Transcatheter occlusion of secundum type ASD provides prominent clinical improvement, as well as a regression in dimensions of cardiac chambers. Nevertheless, this technique has drawbacks such as distal migration and residual shunts. Consequently, we think that unfavorable anatomy and device diameter are major issues in device migration. Oversizing also increases the migration risk.     

Early postoperative interventional ASD-closure for severe atrial right to left shunt in a neonate with common arterial trunk

Although closure of an atrial septal defect (ASD II) with an occluding device in the first year of life is not a routine procedure, it is a feasible treatment, even in neonates. Case reports on the off-label use of Amplatzer devices have been repeatedly published, but there are no reports on using the Amplatzer Duct Occluder (ADO) to close an atrial septal defect in a neonate. We report on a successful catheter closure of an ASD II with ADO in a severely cyanotic neonate, seven days after surgical repair of common arterial trunk. Due to progressive cyanosis and clinical signs of right ventricular failure, which developed after common arterial trunk repair, the neonate underwent cardiac catheterization. Diastolic filling impairment of the right ventricle (right ventricle hypertrophy, pulmonary regurgitation, and residual right ventricle outflow tract obstruction) was thought to be the cause of impaired right ventricle diastolic filling, resulting in the right-to-left shunt at the atrial level. Under transesophageal echocardiographic guidance, ADO was delivered through a 5 French sheath into the atrial septal defect. Amplatzer duct occluder closed the defect and proved to be stable in position after disconnection. During the procedure, the child was stable and then transferred to the intensive care unit with significantly improved oxygen saturation. This is the first report on placing a duct occluder in the atrial septal position, which is a novel procedure for-small neonates.Catheter interventional device closure of an atrial septal defect is the first line treatment in many centers and is routinely performed in patients aged 4-6 years. Device closure of an atrial septal defect (ASD) in the first year of life is not a routine procedure, because of known problems (1), but is feasible (2) even in neonates (3). Case reports on the off-label use of Amplatzer devices have been repeatedly published (4). The Amplatzer duct occluder was initially developed to close an open ductus arteriosus (5). To our knowledge, there are no reports on using the Amplatzer Duct Occluder 2 (ADO) to close an ASD II in a neonate. We successfully performed this procedure in a symptomatic neonate shortly after surgical repair of a complex congenital heart disease.     

房间隔缺损经胸超声指导下封堵术50例临床分析

目的探讨经胸超声指导下封堵术在房间隔缺损治疗中的价值。方法回顾分析50例经导管封堵治疗房间隔缺损患儿的疗效。结果 47例成功,3例失败,术后随访1月～2年,无不良并发症。结论经胸超声指导下封堵术治疗房间隔缺损安全,有效,创伤小,操作简单,住院时间短,是一项有发展前景的治疗方法。     

Outcome of Transcatheter Closure of Oval Shaped Atrial Septal Defect with Amplatzer Septal Occluder

Purpose

For the successful completion of transcatheter closure of atrial septal defects with the Amplatzer septal occluder, shape of the defects should be considered prior to selecting the device. The purpose of this study is to evaluate the results of a transcatheter closure of oval shaped atrial septal defect.

Materials and Methods

From November 2009 until November 2011, cardiac computed tomography was performed on 69 patients who needed a transcatheter closure of atrial septal defect. We defined an oval shaped atrial septal defect as the ratio of the shortest diameter to the longest diameter ≤0.75 measured using computed tomography. A trans-thoracic echocardiogram was performed one day after and six months after.

Results

The transcatheter closure of atrial septal defect was performed successfully in 24 patients in the ovoid group and 45 patients in the circular group. There were no serious complications in both groups and the complete closure rate at 6 months later was 92.3% in the ovoid group and 93.1% in the circular group (p>0.05). The differences between the device size to the longest diameter of the defect and the ratios of the device size to the longest diameter were significantly smaller in the ovoid group (1.8±2.8 vs. 3.7±2.6 and 1.1±0.1 vs. 1.2±0.2).

Conclusion

Transcatheter closure of an oval shaped atrial septal defect was found to be safe with the smaller Amplatzer septal occluder device when compared with circular atrial septal defects.     

生物陶瓷膜先天性心脏病封堵器与普通镍钛合金封堵器的比较：随机对照

背景：研究表明普通镍钛合金先天性心脏病封堵器镍钛合金表面钝化膜可被破坏,在复杂的机体内环境中其内部镍离子释放使血镍增高,导致封堵器的组织相容性恶化。 目的：评价新型生物陶瓷膜先天性心脏病封堵器的安全性与有效性。 方法：先天性心脏病患者110例,其中房间隔缺损46 例,室间隔缺损32例,动脉导管未闭32 例。按手术先后顺序进行区组随机分组,两组病例各占一半,实验组置入陶瓷膜封堵器CeraTM,对照组置入普通镍钛合金封堵器HeartRTM,术后 24 h,1,3,6,12个月随访观察并发症的发生及心功能改变,包括临床体格检查,经胸超声心动图,心电图以及胸片结果。 结果与结论：对照组1 例房间隔缺损置入后20 h封堵器脱落,实验组1 例房间隔缺损封堵失败,其余患者均成功置入封堵器。置入两种不同封堵器患者在血流动力学资料改善,术中导管操作数据,残余分流率,并发症发生率,减少心脏超容量负荷,改善肺血增多等方面差异无显著性意义(P > 0.05)。说明生物陶瓷膜先心病封堵器临床疗效及安全性与普通镍钛合金封堵器无差异。     

Cardiac tamponade due to perforation by an Amplatzer atrial septal occluder in a patient with Marfan syndrome

Device closure of atrial septum defect was performed using an Amplatzer septal occluder in a 48-year-old patient with Marfan syndrome. Acute tamponade due to perforation was observed 2 months after catheter intervention. Careful consideration of the indication for device closure for atrium septal defect is necessary in patients with Marfan syndrome.     

Assessment of right atrial and right ventricular size in children after percutaneous closure of secundum atrial septal defect with Amplatzer septal occluder

Introduction

The aim of this study was to evaluate the right atrial (RA) and right ventricular (RV) size, and the speed of their normalization, in children after percutaneous closure of secundum atrial septal defect with the Amplatzer septal occluder.

Material and methods

The study group consisted of 42 children, aged 4.5 to 18.5 years. The following measurements (indexed to body surface area) were performed using 2D echocardiography: longitudinal, transverse axis and area of RA, RV inflow dimensions at one-third, and halfway between the tricuspid annulus and the apex (in the apical 4-chamber view), short axis and M-mode RV diastolic dimensions. All measurements were obtained 24 h and 1, 3 and 12 months after the procedure, then annually over 4 years of follow-up, and compared with the values obtained from the control groups.

Results

A significant decrease in all RA and RV values was observed after 24 h. Right ventricular transverse dimension normalized after 1 month, the RA longitudinal axis and area and the RV inflow dimensions after 3 months, and the RA transverse axis and M-mode RV diastolic dimension after 2 years, but the ratio of transverse to longitudinal RA axis remained significantly higher.

Conclusions

Right atrial and right ventricular measurements decrease rapidly during the first 24 h, and most of them normalize within a 3-month period. M-mode RV diastolic dimension does not capture the real RV changes. Amplatzer septal occluder closure of ASD influences the RA geometry, which is reflected by the higher transverse to longitudinal RA axis ratio.