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。     

经导管Amplatzer房间隔封堵器关闭儿童继发孔型房间隔缺损:应用限度及技术探讨

为探讨Amplatzer房间隔封堵器 (ASO)在儿童中的应用限度 ,并进行方法学评价 ,共有68例符合手术指征的继发孔型ASD患儿接受了经导管ASO封堵术。术中经右上肺静脉造影、经食道超声心动图 (TEE)测量ASD位置、大小及周围关系 ,并以扩张球囊测量ASD伸展直径 ,按此选择等于或大于其1mm～2mm的封堵器 ;对于>25mm伸展直径的ASD或房缺主动脉根部前缘缺如的ASD ,所选ASO应大于其2mm～4mm。房缺前缘近主动脉根部的缺如并不影响装置的成功放置 ,但房缺后上缘是否有足够距离对手术的成功是决定性的。手术操作按常规进行。术后即刻行TEE或TTE检查观察治疗效果 ,此后定期检查评价疗效。结果68例患儿ASD术前TEE直径 (13.26±4.74)mm ,球囊伸展直径 (15.96±5.44)mm ,选用封堵器腰部直径 (10～32)mm,平均 (16.35±5.81)mm。68例均一次手术封堵成功 ,技术成功率100 % ;65例术后即刻TEE/TTE检查示完全封堵无分流 ,完全封堵率95.6% ;3例术后发生无血液动力学意义的少量残余分流 ,残余分流率4.4 % ,2例24小时后TTE复查分流消失 ,1例1年后消失。除2例装置释放后曾出现一过性房性早搏 (2.9 %)外 ,无其它并发症发生。结果表明虽然ASO对堵塞继发孔型房缺安全有效、无并发症、无死亡率、装置结构简单、操作方便、可多次回撤与重新     

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     

应用Amplatzer双盘闭合器关闭小儿继发孔房间隔缺损

目的探讨应用Amplatzer双盘闭合器关闭小儿继发孔房间隔缺损（ASD）的临床效果。方法71例ASD患儿。男33例,女38例;年龄2～15岁,平均（7±4）岁;体重10～50kg,平均(22±11)kg。在经胸超声（TTE）的四腔心切面和剑下切面观察ASD的位置并测量ASD直径,测量房间隔（IAS）直径。在X线和超声帮助下用Amplatzer测量球囊导管测量ASD最大伸展径。根据所测得的ASD伸展径选择与之相同或比ASD大1～2mm腰部直径的Amplatzer闭合器堵闭71例患儿的ASD。术后随访疗效,追踪残余分流率和并发症。结果应用此法关闭71例ASD,全部成功。其残余分流率为2.8％。此方法并发症较少,疗效较好。本组资料分析示TTE测得的ASD径与测量球囊导管测得的ASD伸展径相关性好,从TTE测得的ASD径推算ASD伸展径的直线回归方程式6.54+0.97×TTE测得的ASD径（心尖四腔心）。结论经导管关闭继发孔ASD适应证为（1）年龄≥2岁,体重≥10kg,ASD直径≤30mm的单纯继发孔ASD或合并肺动脉瓣狭窄;（2）IAS≥ASD伸展径＋14mm;（3）ASD下缘与二尖瓣距离＞5mm,上下腔缘、后缘≥5mm,前缘≥2mm。超声心动图对病例的选择和对经导管监视关闭ASD术有不可忽略的作用,TEE还能弥补TTE的不足。Amplatzer双盘闭合器关闭ASD在儿科有较好的结果,但其疗效仍需长期随访。     

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。     

经胸超声心动图在高海拔地区儿童房间隔缺损封堵术中的应用

目的探讨经胸超声心动图(TTE)在高海拔地区儿童ASD封堵术中的应用价值。方法选取本院住院的ASD 168例,采用TTE多个切面观察ASD大小、周缘情况,指导选择封堵器,术中监测和引导封堵进入、封堵器释放观察封堵牢固程度及有无分流。结果 ASD患儿168例经TTE测量缺损直径为4～32 mm,封堵器型号为8～38 mm。155例单纯单孔型ASD中,153例封堵成功,其中9例为二次封堵成功,2例因ASD直径大、边缘软、距下腔静脉距离<4 mm,封堵失败。双孔或多孔型ASD 4例患儿中3例双孔型选用一个封堵器封堵成功,1例3孔型ASD选用2个封堵器封堵成功。ASD并PDA、VSD、肺动脉瓣狭窄患儿,分别先封堵PDA、VSD及球囊扩张脉动脉瓣狭窄成功后再封堵ASD,封堵成功。结论 TTE在术前检查和术中指导ASD封堵器的放置是一种可行、有效、简便的方法。     

食管超声引导下经皮儿童房间隔缺损封堵术的疗效评价

目的探讨儿童单纯经食管超声心动图(Transesophageal Echocardiography,TEE)引导下经皮房间隔缺损(Atrial Septal Defect,ASD)封堵术的可行性、安全性和有效性。方法收集2014年11月至2016年8月单纯TEE引导下经皮封堵ASD患儿118例,男性51例,女性67例,年龄13~180个月,平均(68.39±39.12)个月,体重10~77 kg,平均(21.14±11.34)kg。术中采用TEE引导并监测房间隔缺损封堵术的全过程。术后门诊随访3~6个月,予经胸超声心动图(Transthoracic echocardio-graphy,TTE)检查,评估封堵效果。结果 TEE引导下经皮成功封堵单孔型继发孔ASD 118例。继发孔ASD大小3~24 mm,平均(9.52±4.12)mm,封堵器大小6~32 mm,平均(14.19±4.60)mm。118例均顺利完成封堵术,术后即刻TEE检查及术后3~6个月TTE随访,均未见封堵器移位、瓣膜损伤、心包积液、外周血管损害等并发症。结论 TEE引导下经皮封堵儿童ASD安全有效,成功率高,并发症的发生率低、设备投入少,易于推广。     

超声心动图在房间隔缺损Amplatzer装置经心导管介入治疗中的应用

自 1976年King和Mills首先用双伞形补片装置成功关闭继发型房间隔缺损 (atrialseptaldefect ,ASD)以来 ,经导管介入性治疗ASD得到迅速发展 ,封堵装置先后经历了Rashkind双面伞、Lock蚌壳、Sideris可调钮扣式补片等 ,1997年AmplatzK推出的Amplatzer蘑菇状封堵器成为当前广泛使用的封堵装置[1～ 3 ] 。而超声心动图在ASD经导管封堵治疗的术前筛查、术中监视及术后效果评价中起着重要作用。本文就超声心动图在ASD经心导管关闭术中的应用价值作一综述。1　二维超声心动图 (two dimensionalechocardiography ,2DE)在ASD介入治疗中的应…     

儿童动脉导管未闭和房间隔缺损的介入治疗

目的 评价应用Amplatzer封堵器治疗儿童房间隔缺损(ASD)和动脉导管未闭(PDA)的效果、安全性夏共并发症等。方法 超声心动图及临床诊断ASD、PDA患儿，在透视和(或)经胸超声心动图(TTE)下置入Amplatzer封堵器，术后24h、1个月、3个月、6个月、1年及以后每年分别经胸超声、心电图和X线胸片检查评价治疗效果。结果 16例ASD患儿，球囊测量值13～28mm，选择封堵器直径13～30mm；25例PDA患儿。造影测量值2～7．7mm，选择封堵器直径4～12mm。技术成功率为100％，术中未发生任何并发症，无急诊手术病例。术后即刻造影或TTE显示10例存在残余分流，术后3个月TTE检查所有病例无残余分流和再通，肺动脉压下降。结论 应用Amplatzer封堵器治疗PDA和ASD，具有操作简单、安全、损伤小、成功率高等优点，适合儿童继发孔型ASD及各种类型PDA的介入治疗。     

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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。     

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.     

Transcatheter closure of secundum atrial septal defects, a ventricular septal defect, and a patent arterial duct

We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.     

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.     

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.     

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目的研究经胸超声心动图(TTE)在继发孔型房间隔缺损(ASD)介入治疗的病例筛选及封堵器选择方面的应用价值。方法回顾分析2002-03—2006-03于山东大学山东省立医院小儿心脏科行介入治疗的54例继发孔型ASD患儿,统计其术前TTE所测的ASD的形态、大小、边缘情况等,对术前TTE测得的ASD最大径、X线测得的球囊腰径及TTE测得的球囊径分别与所用封堵器型号大小进行统计学分析比较,并进行TTE测得的ASD最大径与封堵器型号大小的相关性分析,计算回归方程。结果54例均成功封堵,手术时间20~145(57.64±24.89)min,曝光时间3.1~31.5(9.22±7.41)min,住院天数3~10(5.74±1.72)d。其中有15例患儿存在ASD单一边缘不够标准,均封堵成功。术前TTE测得的ASD最大径[4~33mm,(16.31±7.34)mm]、术中X线测球囊腰径[6.7~28mm,(19.80±7.24)mm]及TTE测球囊径[9.6~24.8mm,(19.92±6.38)mm]与封堵器大小[5~36mm,(18.85±7.89)mm]差异均无显著性意义(P>0.05)。且术前TTE测得的ASD最大径与封堵器型号有良好的线性相关(r=0.945,P<0.05),计算回归方程为封堵器型号=1.015×(TTE测得的ASD最大径)+2.3mm。结论TTE的应用,使ASD介入治疗病例的筛选得到了保证。作为一种无创性影像学诊断方法,对ASD封堵器选择的评估有重要的应用价值。     

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.     

Transthoracic Echocardiography Guidance of Transcatheter Atrial Septal Defect Closure in Children

Transesophageal echocardiography (TEE) guidance is part of interventional closure of secundum atrial septal defect (ASD) in children and adults. However, sometimes TEE is impossible for technical or anatomical reasons. If available, intracardiac echocardiography can be used, but especially in children, transthoracic echocardiography (TTE) can be an easy, safe, and cheap alternative. We report two cases in which TEE was replaced by TTE during percutaneous ASD closure. In the first case VACTERL association with a surgically repaired tracheoesophageal fistula was a relative contraindication to TEE. In the second case, technical failure of the transesophageal probe occurred during the procedure. In both cases the ASD was successfully closed with an atrial septal occluder device under TTE guidance. Using TTE can be sufficient and safe in children with good imaging windows, especially from subcostal views.