超声引导Amplatzer封堵器关闭房间隔缺损的初步体会

目的　超声引导Ａｍ ｐｌａｔｚｅｒ封堵器经导管关闭房间隔缺损（ＡＳＤ）。方法　１９例待外科手术Ⅱ孔ＡＳＤ患者，１６例经食道彩色多普勒超声心动图（ＴＥＥ）、３例经胸彩色多普勒超声心动图（ＴＴＥ）检查符合条件而行经导管ＡＳＤ封堵术。在ＴＥＥ引导（３例ＴＴＥ）下，以ＡＳＤ最大伸展径或加１～２ ｍ ｍ 为标准，选择Ａｍｐｌａｔｚｅｒ封堵器型号，导管送封堵器到ＡＳＤ处，依次释放其左房伞、腰部和右房伞，腰部卡于ＡＳＤ口处，两伞贴于房间隔两侧。结果　３例患者ＡＳＤ最大伸展径＞ ３４ ｍｍ ，没有相应大的封堵器而放弃封堵术，其余１６例成功地进行了ＡＳＤ封堵。超声测量的ＡＳＤ径［（１８．０６±７．００）ｍｍ ］小于ＡＳＤ最大伸展径［（２２．５６±６．２５）ｍ ｍ ］，差异有显著性（Ｐ＜ ０．０１）。术后立即、２４ ｈ、１个月、３个月行ＴＴＥ检查，１６例患者封堵器位置合适、稳定，均无残余分流。所有患者术中及术后均无并发症。结论　用Ａｍ ｐｌａｔｚｅｒＡＳＤ封堵器经导管关闭ＡＳＤ，超声在病例选择、引导封堵器置入及术后疗效观察等方面有极重要的作用。

Echocardiographic guidance of transcatheter closure of atrial septal defect

Objective This study reports our experience of echocardiographic guidance with transcatheter closure of atrial septal defects(ASD)in patients,using the Amplatzer,a new occlusion device.Methods Nineteen patients with secundum ASD waiting for surgical treatment met transesophageal echocardiography(TEE)3 transthoracic echocardiography(TTE)]for transcatheter closure.The Amplatzer size was chosen to be equal to or 1～2mm more than the stretched diameter of ASD.Under uhrasound guidance,The device was advanced to ASD with guiding sheath,and then its left disk,waist and right disk was deployed in turn,Once its position was optimal,it was released.Results Sixteen patients were treated successfully except 3 patients with:>34mm stretched diameters,which were too large for the Amplatzers.The mean ASD diameter by echcardiography was significantly smaller than the mean stretched diameter of the ASD(18.06±7.00)mm vs(22.56±6.25)mm].The devices'positions were optimal and no residual shunt was found by TTE immediately,24 h,1 month and 3 months after the procedure.NO complication was observed during the 3 months fellow up. Conclusions Echocardiography was very important in the selectign of patient,the guidance of the device deployed and the follow-up in the transcatheter closure of ASD with the Amplatzer.