房间隔缺损介入治疗封堵器的选择对心脏重构的影响

目的 探讨经导管介入封堵术治疗继发孔型房间隔缺损(ASD)的封堵器选择对其疗效及心脏形态学重构的影响.方法 入选146例ASD患者,年龄13.5～70.0(33.5±12.4)岁.其中73例(A组)根据椭圆周长数学公式计算缺损直径选择封堵器型号,另外73例(B组)根据超声心动图测量长径选择封堵器型号.应用经胸超声心动图分别测量ASD患者经导管封堵治疗术前、术后3 d、3个月和6个月的左心房收缩末期横径(LALD)、右心房横径(RALD)、RALD/LALD比值、右心室舒张末期内径(RVDD)、左心室舒张末期内径(LVDD)、RVDD/LVDD比值及肺动脉内径.结果 A组缺损内径为(20.16±4.98)mm,B组为(21.36±5.69)mm,差异无统计学意义.封堵器直径A组小于B组[(21.95±6.78)mm比(25.85±6.75)mm,P<0.05].142例封堵术成功,两组成功率差异无统计学意义,无主要手术相关并发症发生.随访6个月无残余分流发生.两组患者随访期间RALD、RVDD、RALD/LALD和RVDD/LVDD比值明显下降,肺动脉内径逐渐缩小,LALD、LVDD逐渐增大.A组改善心房重构程度明显大于B组(P<0.05).结论 椭圆形周长公式在非圆形ASD封堵器选择中具有重要应用价值;封堵器大小对心脏重构有明显影响.     

房间隔缺损介入治疗1000例临床分析

目的:评价房间隔缺损(ASD)介入治疗的临床疗效.方法:全组1 000例,男421例,女579例,年龄1.2～76(23±4)岁,经临床、心电图、X线及经胸超声心动图(TTE)检查诊断为ASD继发孔型,TTE测不同切面ASD的最大直径6～34(19±4)mm,其中单孔ASD为970例,多孔ASD 30例.结果:1 000例均1次封堵成功,技术成功率99%,所用封堵器直径为10～40(22±6)mm,30例多孔ASD,有26例置入1个封堵器直接封堵2个缺损孔,4例分别用2个封堵器加以封堵2个缺损孔.结论:ASD的介入治疗具有操作简便易行、无创伤、风险小、安全可靠、技术成功率高、住院时间短等优点,深受患者及临床医生的欢迎,已成为当今治疗ASD的首选方法.     

房间隔缺损介入治疗480例临床分析

目的评价房间隔缺损(ASD)介入治疗的临床疗效。方法全组480例,男198例,女282例,年龄1·2~72岁(24±8)岁;均经临床、心电图、X线及经胸超声心动图(TTE)检查诊断为ASD继发孔型;TTE测不同切面ASD的最大直径6~34mm(16±4mm);其中单孔ASD为470例,多孔ASD10例。结果480例均一次封堵成功,技术成功率100%,所用封堵器直径为10~40mm(20±6mm),10例多孔ASD,有6例置入一个封堵器直接封堵二个缺损孔,4例分别用二个封堵器封堵二个缺损孔。结论ASD的介入治疗具有操作简便易行、无创伤、风险小、安全可靠、技术成功率高、住院时间短等优点,可作为当今治疗ASD的首选方法。     

房间隔缺损介入治疗100例临床分析

目的:评价房间隔缺损(ASD)介入治疗的临床疗效;方法:全组100例,经临床、心电图、X线及经胸超声心动图(TTE)检查诊断为ASD继发孔型,TTE测不同切面ASD的最大直径6～32(16±2)mm,其中单孔ASD为95例,多孔ASD 5例.结果:100例均一次封堵成功,技术成功率100%,所用封堵器直径为10～40(20±6)mm,5例多孔ASD,2例置入1个封堵器直接封堵2个缺损孔,3例分别用2个封堵器加以封堵2个缺损孔.结论:ASD的介入治疗具有操作简便易行、无创伤、风险小、安全可靠、技术成功率高、住院时间短等优点.     

经导管介入治疗儿童和成人室间隔缺损的比较

目的 探讨经导管介入治疗室间隔缺损在儿童和成人的差别.方法 回顾性分析142例成功接受封堵器介入治疗的室间隔缺损患者,其中儿童组113例,成人组29例.比较两组患者应用特殊封堵器、术后心律失常、术后残余分流的比率以及手术时间、术后24 h C反应蛋白(CRP)和心肌肌钙蛋白(cTnI)测定值.结果 儿童组和成人组患者应用特殊封堵器、术后心律失常及术后残余分流比率分别为23.9%比27.6%、32.7%比37.9%、10.6%比6.9%;两组患者的手术时间、术后24 h CRP和cTnI测定值分别为(50±35)min比(47±20)min、(2.31±1.23)mg/L比(2.29±1.15)mg/L、(0.18±0.14)ng/L比(0.12±0.08)ng/L,差异均无统计学意义(P＞0.05).结论 应用封堵器经导管介入治疗室间隔缺损在儿童和成人中未见明显差别.     

中老年房间隔缺损患者介入治疗前心脏CT检查的价值

目的 评估心脏CT在筛查拟行房间隔缺损(ASD)封堵术中老年患者合并的心血管病变及指导封堵器选择方面的价值。方法 对63例拟行ASD封堵术的50 ～ 77( 56.87±5.79)岁患者行冠状动脉CT造影检查,了解心血管病变情况。随后行ASD三维重建,并测量ASD大小。分析经胸超声心动图与CT的ASD直径测量值之间以及ASD直径的CT测量值与ASD封堵器腰部直径之间的关系。结果 14例患者依据心脏CT检查结果调整了治疗方案：8例患者诊断为ASD合并冠心病,均行常规冠心病治疗,其中2例患者行经皮冠状动脉介入治疗和ASD封堵术,1例患者行冠状动脉旁路移植术和ASD封堵术,5例患者行药物治疗和ASD封堵术;2例患者因ASD后下缘残端不完整,而放弃介入治疗;1例患者超声心动图示ASD后下缘残端不完整,而CT显示缺损边缘尚可,行ASD封堵术;除外ASD 1例;合并部分型肺静异位引流(PAPVC)1例,行外科修补术;合并动脉导管未闭1例,行动脉导管未闭和ASD封堵术。经胸超声心动图与CT的ASD直径测量值之间呈正相关(r=0.80,P＜0.01),其线性回归方程为Y=0.84X +8.85(R2=0.63,P＜0.05)。ASD直径的CT测量值与ASD封堵器腰部直径之间呈正相关(r=0.92,P＜0.01),其线性回归方程为y=0.93X +4.78(R2=0.84,P＜0.05)。结论 对于拟行ASD封堵术的中老年患者,术前心脏CT检查可有效诊断合并的冠心病及其他心血管畸形,并能指导封堵器的选择。     

经导管同期治疗复合型先天性心脏病的疗效和安全性

目的:探讨经导管介入同期治疗复合型先天性心脏病的可行性、方法及疗效.方法:13例患者,男5例,女8例.其中房间隔缺损(ASD)合并肺动脉瓣狭窄6例,ASD合并动脉导管未闭(PDA)4例,ASD合并膜部室间隔缺损2例,PDA合并肺动脉瓣狭窄1例.ASD合并其他畸形的患者,均先治疗其他畸形,最后行ASD封堵.PDA合并肺动脉瓣狭窄者,先行肺动脉瓣狭窄球囊扩张术,最后封堵PDA.结果:13例患者均经导管一次治疗成功.ASD合并肺动脉瓣狭窄6例,跨肺动脉瓣压差由术前平均(138.3±41.4)mmHg下降到术后平均(12.0±5.6)mmHg,有显著性差异(P＜0.01).所用ASD封堵器直径为8～24 mm.ASD合并PDA4例,PDA最窄径2～5 mm,封堵器直径为6～8 mm;ASD封堵器直径为8～28 mm.ASD合并膜部室间隔缺损2例,室间隔缺损直径分别为3.5 mm和5.0 mm,用直径6 mm和8 mm的双盘状室间隔缺损封堵器封堵成功,所用ASD封堵器的直径为12 mm和18 mm.1例PDA合并轻度肺动脉瓣狭窄,用聚乙烯球囊扩张、PDA用4 mm封堵器治疗成功.结论:经导管介入同期治疗复合型先天性心脏病具有技术上的可行性、安全性和良好的治疗效果.     

房间隔瘤并发继发孔型房间隔缺损介入封堵术的临床评价

目的:评价房间隔瘤(ASA)并发继发孔型房间隔缺损(ASD)介入封堵术的可行性、安全性和疗效.方法:16例(男4例,女12例),年龄12～66(30.6±14.1)岁.经临床、心电图、X线及经胸超声心动图(TTE)检查诊断为ASA并发继发孔型ASD.TTE检查ASA均膨入右心房, ASD最大直径10～32(17.1±10.4)mm.其中单孔ASD 14例,双孔ASD 2例,孔间距离均小于7 mm.结果:16例均一次封堵成功,成功率100%.所用封堵器的直径为16～42(28.5±6.99)mm.2例双孔ASD中,置入1个封堵器直接封堵2个缺损孔.术中TTE监测检查示15例完全闭合, 1例有少量残余分流.术后3 d复查TTE示均无残余分流;6个月、1年后复查示9例心脏大小恢复正常, 均无残余分流,无封堵器移位及其他并发症.结论:介入封堵治疗ASA并发继发孔型ASD是可行、安全的, 可获得良好的封堵效果.     

房间隔缺损合并肺动脉瓣狭窄介入治疗的临床评价

目的:探讨房间隔缺损(ASD)合并肺动脉瓣狭窄(PS)行介入治疗的临床安全性及其疗效。方法:31例患者,年龄2.5~67(中位年龄31)岁;24例经胸超声心动图(TTE)诊断为ASD合并PS,房间隔缺损最大直径为7~27(16.0±4.8)mm,7例超声心动图术前漏诊ASD,肺动脉瓣狭窄压差35~120(89.8±22.9)mm Hg(1mm Hg=0.133k Pa),所有患者术前行右心室造影检查。先行经皮球囊肺动脉瓣成形术(PBPV),而后置入房间隔缺损封堵器闭合缺损,选择的封堵器直径为12.0~38.0(22.6±5.9)mm。结果:本组28例行PBPV术及ASD介入封堵治疗28均获得成功;其中3例封堵器脱落入主动脉,介入方法取出后,再置入较大封堵器封堵成功,PBPV术后即刻右室收缩压由术前(89.8±22.9)mmHg下降至(39.8±11.3)mm Hg,肺动脉右心室跨瓣压差由术前mm Hg降至(14.8±8.9)mm Hg(P<0.001)。右心室舒张末压由术前(9.9±0.28)mm Hg降至(5.07±0.57)mm Hg(P<0.005),PBPV术后即刻跨瓣压差下降达优良为100%。术后超声心动图随访于术后即刻、1、3及6个月,疗效满意,房间隔未见残余分流。结论:同期介入治疗肺动脉瓣狭窄合并房间隔缺损安全可行,效果良好,但由于合并PS患者,超声心动图术前常常低估或漏诊ASD,因此,需先行肺动脉瓣球囊扩张术后,超声心动图重新复核ASD大小,再行ASD封堵术,必要时分期手术。     

房间隔缺损封堵术后头痛与封堵器形态相关分析

目的:研究房间隔缺损封堵术后头痛与封堵器形态之间的关系,以此探讨术后头痛的原因和机制。方法:继发孔型房间隔缺损患者183(男66,女117)例,年龄6~72(30.1±18.5)岁。经胸心动超声(transthoracic echocar-diography,TTE)测量房间隔缺损最大直径为8~35(19.8±7.5)mm,选用的封堵器大小为10~44(25.9±8.9)mm。结果:术后3个月新出现头痛症状患者为16例,发生率为8.7%。头痛组房间隔缺损(atrial septal defect,ASD)缺损大小为(27.3±6.2)mm,无头痛组为(17.1±7.2)mm,头痛组缺损明显大于无头痛组(P<0.01)。头痛组封堵器直径、超声测量封堵器的厚度均较无头痛组大(均P<0.01)。封堵器直径与缺损大小的差值和封堵器直径与术后封堵器直径的差值头痛组亦明显大于无头痛组(P<0.05或P<0.01)。多因素相关分析显示,头痛与封堵器厚度显著相关(P<0.01),而与年龄、缺损大小、封堵器直径等不相关。结论:封堵器厚度越厚,头痛症状发生率越高。头痛可能与封堵器表面内皮化不全或内皮化进程延长有关。     

经胸超声心动图在继发孔房间隔缺损封堵术围手术期中的应用价值

目的评价经胸超声心动图（VrE）在继发孔房间隔缺损（ASD）围手术期中的应用价值。方法术前筛选86例有外科手术适应证的继发孔ASD患者,TTE测量各切面ASD大小及残边情况,指导选择封堵器（ASO）型号,术中监测ASO置放及释放过程,术后随访观察。结果86例患者术前TTE测得ASD最大直径5～34（24．4±5．63）mm,所用ASO直径为8—40（27．5±7．12）mm。TTE成功引导81例ASO置人,总成功率为94．2％,其中双孔ASD2例,均置入单个ASO成功。5例术后即刻有微量或少量残余分流,术后3个月复查TTE分流完全消失。结论经导管ASD封堵术是安全可行的方法,T珏对ASD封堵术前病例选择、残边评估、ASO型号选择、术中监测ASO的置放全过程和术后疗效评价有重要临床价值。     

经静脉闭合房间隔缺损的疗效观察

目的 :评价经静脉置入 Amplatzer封堵器治疗继发孔型房间隔缺损 (ASD)的疗效。方法 :2 4例患者术前经多普勒超声心动图检查 ASD直径为 6～ 30 (18.96± 7.0 3) m m。在透视及经超声心动图引导下经静脉置入Am platzer封堵器闭合 ASD。结果 :2 4例 ASD直径的球囊测量值为 15～ 36 (2 6 .2 5± 7.5 7) mm ,选择的封堵器直径为 14～ 36 (2 6 .5 2± 7.15 ) m m。 2 4例封堵器置入均获得成功 ,术中无并发症 ,1例在术后第 3天出现 度 型房室传导阻滞 ,2周后恢复。 7例术后即刻超声检查显示微量残余分流 ,术后 1周复查均无分流。结论 :经静脉置入 Amplatzer封堵器治疗 ASD是一种有效的非外科手术方法。     

成人继发孔型房间隔缺损形态学特点及其对经导管封堵术的影响

目的探讨成人继发孔型房间隔缺损(ASD)边缘形态学特点及其对封堵术的影响。方法收集本院1997年9月—2005年12月符合封堵治疗适应证的272例40岁以上成人继发孔型ASD,采用Amplatzer法封堵ASD。封堵前均采用经胸超声心动图(TTE)和经食管超声心动图(TEE)对缺损形态学进行全面评价,按照残存边缘条件进行分组。分别对两组的缺损大小、边缘形态和长短、封堵器直径、成功率,残余分流率和并发症等指标进行分析。结果本组全部272例中存在短边者96例,占35.3%;薄边者61例,占22.4%。短边以前缘最常见69例(71.9%),长度(1.4±1.4)mm;薄边以后下缘最常见,占59.0%(36例),长度2～23mm,平均长度(6.7±6.3)mm。A组[短边和(或)薄边]共135例,占49.6%,B组(边缘良好)共137例,占50.4%。A、B两组在性别、年龄方面差异均无统计学意义,两组技术成功率、残余分流和并发症发生率等差异亦无统计学意义。但两组缺损TTE径[(18.9±5.5)mm和(16.5±4.8)mm,P<0.01]、TEE径[(22.7±5.0)mm和(20.0±5.5)mm,P<0.01]、所选用的封堵器直径[(29.1±5.7)mm和(26.0±5.9)mm,P<0.01]以及肺动脉收缩压[(36.9±11.9)mmHg(1mmHg=0.133kPa)和(32.6±9.1)mmHg,P<0.01]差异均有统计学意义,A组均高于B组。A、B两组封堵器直径与TTE和TEE所测量的直径之间均具有较好的相关性(A组TTE:r=0.709,TEE:r=0.850;B组TTE:r=0.716,TEE:r=0.915)。B组均高于A组,而且两组中封堵器直径与TEE值的相关性均高于与TTE的相关性。结论成人继发孔型ASD近一半合并边缘短缺和(或)边缘变薄,但选择直径更大的封堵器仍可以成功实施封堵治疗。而根据TTE和TEE,特别是后者所测量的直径能够准确地选择合适的封堵器。     

Transcatheter closure of atrial septal defects with the Amplatzer septal occluder--a Japanese clinical trial.

This study reports the results of a Japanese clinical trial of transcatheter closure of atrial septal defects (ASD) using the Amplatzer septal occluder (ASO). Thirty-five patients with secundum ASD underwent transcatheter closure using the ASO at a median age of 12.9 years (range, 3.2-29.2 years) and a median weight of 39.2kg (range, 11.6-65.1 kg). The ASO was successfully implanted in 34 patients. The mean ASD diameter of the 34 patients measured by transesophageal echocardiography was 11.7 +/- 4.2mm (range, 5.0-20.8mm) and the mean balloon stretched diameter was 16.8 +/- 4.2 mm (range, 9-25 mm). The mean ASO size was 16.9 +/- 4.3 mm (range, 9-26mm). Complete closure rate at 1 day and 1 year after closure was 91% and 97%, respectively. One patient developed a transient second-degree atrioventricular block during the implantation procedure. No other complications occurred. Transcatheter closure of ASD using the ASO is effective and safe.     

Choice of device size and results of transcatheter closure of atrial septal defect using the amplatzer septal occluder

The impact of device size choice on closure results was analyzed in 138 (101 females, 37 males; age 0.5-84.0 years) consecutive patients who underwent transcatheter closure of the secundum atrial septal defect (ASD) using the Amplatzer septal occluder (ASO). The balloon stretched diameter (SD) of ASD was 19.5 +/- 7.2 mm in 123 patients with single defects, and 20.4 +/- 6.6 mm for the largest defects in 15 patients with multiple ASDs. The difference (delta) between ASO size chosen for closure and the stretched diameter of the defect was calculated and divided into groups: A (delta < -2 mm); B (delta -2.0 to -0.1 mm); C (delta = 0); D (delta 0.1-2.0 mm) and E (delta > 2 mm). The results demonstrated that immediate and 24-hour complete closure rates were significantly higher in patients in groups C and D (P < 0.001). However, at 6-month follow-up, the complete closure rates were similar in patients of groups A-D, while patients of group E had a lower closure rate of 75%. The complication rates were similar in all groups. In conclusion, a choice of a device size identical to or within 2 mm larger than the SD of the defect should be used to maximize the closure rates of ASD using the ASO.     

New echocardiographic diameter for Amplatzer sizing in adult patients with secundum atrial septal defect: preliminary results.

Anatomical atrial septal defect (ASD) diameter measured by transesophageal echocardiography (TEE) underestimates the Amplatzer septal occluder (ASO) size for ASD closure. The aim of this study is to investigate whether a new echocardiographic diameter (procedural ASD diameter) may enable precise measurements of ASO device size. Fifty adult patients with secundum ASD were evaluated by TEE for percutaneous closure. The procedural ASD diameter was measured using the steadier rim borders where thickness was 2.5 mm. Out of the 50 patients, 12 were considered unsuitable for Amplatzer device closure. The other 38 patients underwent percutaneous closure. The mean anatomical ASD diameter was 14.8 +/- 7.0 mm, the mean procedural ASD diameter measured 19.5 +/- 8.1 mm, and the mean stretched balloon diameter (SBD) was 20.0 +/- 8.0 mm. ASO device size was 20.1 +/- 8.0 mm. At linear regression analysis, a high correlation (r = 0.99) was found between procedural ASD diameter and SBD. Procedural ASD diameter correlates with SBD and may allow reliable prediction of Amplatzer device in an adult population undergoing percutaneous ASD closure.     

三维可视化技术模拟房间隔缺损介入治疗的临床研究

目的 探讨三维可视化技术模拟在房间隔缺损(ASD)介入治疗中的临床价值.方法 应用超声三维体绘制显示ASD及缺损周边心内结构,同时运用三维建模技术绘制数字化仿真装置.对30例ASD介入术患儿仿真装置大小及装置下缘距房室瓣距离与实际所用房隔封堵装置各参数进行比较.结果 三维可视化可显示患儿ASD的位置、形态、大小.仿真装置左心房面直径为(26.07±5.32)cm、右心房面直径为(22.13±5.31)cm,其距二尖瓣、三尖瓣距离分别为(5.76±2.39)和(8.25±2.40)cm,与实际所用Amplatzer封堵装置相应各参数[分别为(25.91±5.32)、(22.08±5.26)、(5.61±2.26)、(8.02±2.48)cm]之间差异无统计学意义(P＞0.05).结论 三维超声可视化作为一种无创性技术可在ASD封堵术前为介入治疗提供更详尽的缺损及装置信息,指导装置选择.     

Comparison of transcatheter closure of secundum atrial septal defect using the Amplatzer septal occluder associated with deficient versus sufficient rims

To evaluate the feasibility of transcatheter closure of secundum atrial septal defects (ASDs) associated with deficient rims (<5 mm) using the Amplatzer septal occluder (ASO), 23 patients (median age 10.7 years) underwent an attempted transcatheter closure. The patients had a deficient anterior rim of 0 to 4 mm (n = 20), an inferior rim of 2 mm (n = 2), or a posterior rim of 4 mm (n = 1) as assessed by transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE). Forty-eight patients with sufficient rims (>5 mm) who underwent closure served as controls. There were no differences between the 2 groups in ASD stretched diameter and device size (p >0.05). Of 23 patients with deficient rims, 17 (74%) had immediate complete closure compared with 44 of 48 patients (92%) with sufficient rims (p <0.05). At 24-hour and 6-month follow-up, the complete closure rates were not significantly different between the 2 groups (91% for patients with deficient rims vs 94% for patients with sufficient rims at 24 hours and 100% vs 93% at 6 months, respectively). The fluoroscopic time and procedure time were longer in patients with deficient rims (13 +/- 7 and 72 +/- 26 minutes, respectively) compared with those with sufficient rims (10 +/- 4 and 61 +/- 22 minutes, respectively). No major complications were encountered either during or after the closure procedure in both groups. Thus, transcatheter closure of ASDs associated with small anterior, inferior, or posterior rims is feasible using an ASO. Long-term follow-up data are still needed to assess long-term safety and efficacy.