应用Amplatzer封堵器治疗先天性心脏病68例

目的：评价Amplatzer封堵器在继发也型房间隔缺损（OSD）和动脉导管未闭（PDA）的介入治疗中的可靠性、安全性和疗效。方法：采用Amplatzer封堵器治疗38例OSD与30例PDA患者，术后24小时，1，3，6月及1年行超声心动图检查，观察封堵效果及无并发症。结果：37例（97．4％）OSD患者成功置入Amplatzer封堵器，其中34例（91．9％），显示即刻封堵完全，3例（8．1％）存在微－少量残余分流。1例28岁男性术后第4天发生无Q波心肌梗死。随访中，未见封堵器移位及再通，右心房、室有不同程度缩小，2例残余分流消失；PDA最窄处直径为2．5－12（平均5．3）mm。29例用PDA封堵器，1例有重度肺动脉高压的粗大PDA采用Amplatzer房封堵器治疗。19例（63．3％）显示即刻封堵完全，所有病例术后24小时（1例48小时）的彩色多普勒检查均未见残余分流。1例发生机械性溶血。随访期中，未出现封堵器移位，、残余分流及再通。结论：用Amplatzer封堵器治疗OSD和PDA是一种安全有效的非外科手术方法，操作简便，创伤小，成功率高。超声心动图在术前、术中、术后均发挥了重要作用。近期疗效满意，远期效果尚需进一步观察。

Transcatheter closure of ostium secundum defect and patent ductus arteriosus using the Amplatzer occluder in 68 patients

Objective To evaluate the feasibility,safety and effectiveness of the Amplatzer occluder in transcatheter closure of ostium secundum defect(OSD)and patent ductus arteriosus(PDA).Methods Thirty eight patients with diagnosed ODS and 30 patients with diagnosed PDA underwent attempted transcatheter closure using the Amplatzer septal occluder.Follow up evaluation was performed with echocardiography at 24 hours and 1,3,6,12 months,and each year after wards.Results The Amplatzer septal occluder was implanted successfully in 37 OSD patients(97.3%).Of these cases,34(91.9%)displayed an immediate complete closure on color Doppler while only 3(8.1%)showed traces of small residual shunt.A 28 year old male developed non Q wave myocardial infarction on the fourth postprocedural day.In the follow up,no device displacement or recanalization was found,oversize of right chambers was decreased and shunt left in 2 patients had gone.The PDA measured from 2.5 to 12mm(mean 5.3)at the narrowest diameter.29 cases of PDA were closed by duct occluder,while one huge PDA complicated with severe pulmonary hypertension was closed by the Amplatzer atrial septal device. Immediate complete closure,was achieved in 19 patients(63.3%),and on color Doppler the occlusion rate at 24 hours(1 patient at 48 h)was 100%.Hemolysis occurred in one patient.No residual shunt or device displacement or PDA recanalization was found in the follow up.Conclusion Transcatheter closure of OSD and PDA using the Amplatzer occluder under the guidance of echocardiography is efficacious easy to do and much less invasive.It has been performed in this hospital with high success rate of implantation and satisfactory instant or short term results,and its long term effect needs further observation.