Effects of transcatheter closure of atrial septal defects on heart rate variability

This study evaluated heart rate variability and its changes in 30 patients before and after transcatheter closure of secundum atrial septal defects. Heart rate variability data from 30 healthy volunteers with normal echocardiographic parameters and no history of atrial septal defects were included as controls. Values for the SD of all the normal RR intervals (SDNN), the SD of the means of all the 5-min segment normal RR intervals (SDANN), and the mean of all the 5-min SDs of normal RR intervals during the 24-h period (SDNN index) in patients with atrial septal defects before transcatheter closure were statistically significantly different from controls. At 6 months after closure of the defects these values were not statistically different from controls. It is concluded that transcatheter closure of secundum atrial septal defects had positive effects on heart rate variability and, consequently, may contribute to less mortality and morbidity.     

房间隔缺损微创封堵术中经食管超声的作用

目的　探讨房间隔缺损 (ASD)闭合器微创封堵术中经食管超声心动图 (TEE)的作用。方法　在TEE监测下为 17例患者进行了房间隔缺损闭合器微创封堵术。首先用TEE准确定位和测量ASD ,确定ASD类型、大小和边缘长短 ,选择合适的患者 ;然后取右前胸 2 .5～ 3 .5cm长的微创切口 ,在TEE引导下 ,经右心房插入特制推送管 ,将闭合器嵌入ASD处 ,达到封堵目的。结果　 17例中 2例TEE发现不符合封堵条件 ,改体外循环下手术。 15例用闭合器封堵成功 ,心内操作时间 10～ 45min ,平均 ( 2 5± 12 )min ,于术后 3～ 4d痊愈出院。 12例患者随访 3～ 9月 ,效果良好 ,无残余分流。结论　TEE对于选择适合闭合器封堵的患者、指导闭合器的释放具有重要的作用。     

Transcatheter closure of atrial septal defects

Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.     

Transcatheter closure of atrial septal defects

Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer^® septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.     

不同年龄段房间隔缺损封堵对心脏重构及心功能的影响

目的:观察各年龄段继发孔型房间隔缺损经导管介入封堵治疗后对心脏几何形态学及右心功能变化的影响.方法:回顾性分析,998-06/2008-10贵州省人民医院心内科收治的房间隔缺损患者109例,男53例,女56例,年龄3.5-70岁.按年龄段分为儿童组(年龄≤7岁,n=31),青少年组(年龄8-18岁,n=42)和成人组(年龄＞18岁,n=36).应用经胸超声心动图分别测量各年龄段房间隔缺损患者经导管房间隔缺损封堵治疗前和治疗后6个月收缩末期左房横径、右房横径、右房横径左房横径、右心室舒张末期内径、左心室舒张末期内径、右心室舒张末期内径左心室舒张末期内径、肺动脉内径及左右心室射血分数的变化.结果:与术前相比,各组房间隔缺损封堵后6个月,右房、右室内径、肺动脉内径缩小,右房横径/左房横径和右心室舒张末期内径/左心室舒张末期内径明显下降,左房、左室内径增大,左、右室射血分数明显改善(P< 0.05-0.01);但儿童组心脏重构逆转及心功能改善程度明显大于青少年组及成人组(P<0.05),青少年组和成人组相比,差异无显著性意义(P＞0.05).结论:继发孔型房间隔缺损介入治疗对不同年龄患者均能有效逆转心脏重构、改善心功能,但儿童阶段效果更好.     

非X线下经胸壁超声全程引导经导管房间隔缺损封堵术的应用研究

目的 探讨非X线下、经胸超声心动图[常规经胸二维超声(TTE)和实时三维超声(RT-3DE)]全程引导经导管房间隔缺损封堵术(TCASD)的方法学要点和临床应用价值.方法应用GE Vivid 7彩色超声诊断仪,普通二维及矩阵3V经胸探头,在完全脱离X线条件下,实时引导11例房间隔缺损(ASD)患者的TCASD术.在常规二维多切面观察的基础上,结合RT-3DE引导多功能导管经腔静脉进入右房;引导导管经缺损进入左房并抵左上肺静脉;引导输送鞘准确进入左房中部;引导封堵器双面伞在左房展开,贴靠入位并准确释放.同期与58例条件类似行常规X线和TTE引导的TCASD患者比较.结果所有手术均顺利完成,无心包填塞等重大并发症发生,与对照组相比,除手术时间显著延长外,研究组在手术即刻及随访3 d、3个月内,残余分流、封堵器移位、房室瓣反流、栓塞及心律失常等并发症发生率与对照组比较差异无统计学意义.结论非经X线条件下、TTE结合RT-3DE全程引导TCASD是安全、经济、实用的超声介入技术,可减少对X线引导封堵的依赖性,对孕妇和儿童实施封堵治疗减少辐射伤害尤为有效.     

超声心动图对儿童房间隔缺损封堵术后左心房收缩功能的研究

目的探讨儿童房间隔缺损（ASD）封堵术后左心房收缩功能变化的特征。方法选择63例ASD患者分别于封堵术前、术后48h及术后3个月分别从机械运动、血流变化、压力变化及组织运动来分析左心房收缩功能。结果封堵术后3个月左心房充盈分数、左房收缩分数及左房射血力较正常组明显增高,左房射血分数、左房动能及心房收缩期心肌组织运动峰速明显减低,左房电机械时间缩短,左房压明显减低。结论儿童房间隔缺损封堵术后3个月左房收缩功能各指标较术前有明显改变。     

Clinical advantage of real-time three-dimensional transesophageal echocardiography for transcatheter closure of multiple atrial septal defects

This study sought to evaluate the usefulness of real-time three-dimensional (3D) transesophageal echocardiography (TEE) to guide the repair of multiple atrial septal defects (ASDs). Of 212 consecutive patients with secundum ASD who were scheduled for transcatheter closure of their ASDs, 27 had multiple ASDs. These patients underwent two-dimensional (2D) transthoracic echocardiography, 2D TEE, and 3D TEE. Overall, 18 patients had two defects, and 9 patients had three or more defects. The latter group included three patients with multi-fenestrated defects. Optimal 3D images were obtained in 93 % of the patients. In patients with two defects, information on the positional relation of the defects was obtained using 2D TEE and 3D TEE in 71 and 94 % of patients, respectively (P = 0.22). The positional relations of the defects could not be evaluated with 2D TEE in patients with three or more defects, whereas it could be evaluated with 3D TEE in all of these patients (0 vs. 100 %, P = 0.008). In all patients, 3D TEE proved superior to 2D TEE for providing sufficient information (96 vs. 48 %, P = 0.002). Procedural success was obtained in 26 patients (96.3 %), without complications. Transcatheter closure of multiple ASDs under 3D TEE guidance is effective and safe. Real-time 3D TEE can provide useful information regarding complex ASD morphology. It can thus contribute to developing a successful treatment strategy, especially in patients with three or more defects.     

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。     

超声心动图监测房室间隔缺损封堵术并发症及手术失败原因探讨

目的:评价超声心动图监测经心导管房室间隔缺损封堵术并发症的价值,并探讨手术失败原因。方法:79例房间隔缺损(ASD)、6例膜部室间隔缺损(VSD)患者在经食管或经胸超声心动图(TEE、TTE)监测下行经心导管封堵术。结果:73例ASD、6例VSD封堵成功。6例ASD封堵失败,其中1例封堵器脱落,游离于右心腔内;2例术中心导管戳破左房耳致急性心包填塞;2例因ASD太大缺乏合适尺寸的封堵器而终止手术;1例为筛孔状ASD。1例ASD术后随访有少量残余分流。结论:超声心动图(TTE和TEE)能够正确估测房室间隔缺损的大小和位置,利于术前的病例选择、术中监测封堵器放置和并发症发生。超声检查详尽了解缺损大小和边缘情况在该手术方法中必不可少。     

房间隔缺损Amplatzer封堵术后右心形态和功能改变的超声心动图观察

目的探讨房间隔缺损行Amplatzer封堵器封堵术后右心形态和功能变化.方法对25例继发孔房间隔缺损患者,分别于术前、术后48～72 h及3个月后行经胸超声心动图检查,测量缺损大小、右心室壁厚度、房室腔径及容积、每搏输出量及射血分数等,并进行比较.结果缺损直径为(2.2±0.6)cm,所有患者均在经胸超声心动图监控下成功植入Amplatzer封堵器;术后48～72 h超声心动图复查,除2例患者残存微量左向右分流外,余患者心房水平分流完全消失;13例患者术后3～6个月复查,原2例残存分流完全消失;术后48～72 h超声心动图检查发现,右心房最大长径及横径,右心室舒张末期长径、横径及前后径,主肺动脉根部内径均明显缩小,右心室舒张末期容积、每搏输出量及射血分数较术前明显减低(P<0.01);术后3个月超声心动图复查发现,患者右心房内径、右心室舒张末期内径及容积、右心室收缩末期横径及容积术后3个月进行性缩小,右心室每搏输出量及射血分数与术后早期相比差异无统计学意义,室间隔异常运动消失.结论房间隔缺损封堵术后右心室前负荷的降低对右心形态有明显影响,右心内径及容积进行性回复,室间隔异常运动消失,代偿增强的右心室每搏输出量、射血分数下降,但并不是持续性降低,而是在新的前负荷水平上达到新平衡,保持右心收缩功能.     

超声在房间隔膨出瘤并继发孔型房间隔缺损封堵术中的应用

目的 探讨超声心动图在房间隔膨出瘤（ASA）并发继发孔型房间隔缺损（ASD）封堵治疗中的应用价值。方法 应用经食管超声心动图（TEE）或经胸超声心动图（TTE）诊断ASA并发ASD17例，所有患者均在X线和术中TTE监测下行封堵治疗，术后TTE跟踪复查评价其疗效。结果 17例患者封堵器置人均获成功，共放置24个封堵器。封堵器选择的大小与术前判断大小相关性好（r=0．91，P〈0．001）。术后即刻显示17例患者21个封堵器处穿隔血流消失，有3例患者3个封堵器处仍有微量残余分流，术后1个月至3年复查1例有微量分流。结论 ASA并发ASD的患者可行封堵治疗且疗效确切，而超声心动图在病例选择、术中引导等方面有其特殊性，应引起超声医生和临床医生的重视。     

房间隔缺损Amplatzer封堵器封堵术后左心血流动力学改变的超声心动图观察

目的探讨房间隔缺损经Amplatzer封堵器封堵术后左心形态和血流动力学的变化。方法65例继发孔型房间隔缺损患者,45例3个月后进行了随访。经胸超声心动图检查分别于术前、术后48~72 h及3个月后进行,测量缺损大小、左室前后径、横径、二尖瓣及主动脉瓣瓣口血流脉冲及组织多普勒流速曲线的相关参数,计算Tei指数和TeiTDI指数。结果房间隔缺损平均孔径(2.5±0.3)cm,舒张末期左室前后径于术后早期和中期扩大,横径于中期扩大,每搏输出量和射血分数迅即持续增加;代偿增强的左室后壁运动幅度恢复。术后早期和中期左室收缩期血流峰值速度均较术前增快,但射血时间无明显延长,术后中期左室血流充盈时间延长。心率、Tei指数及TeiTDI指数封堵术前后无明显变化。结论房间隔缺损封堵术纠正了解剖畸形,使左、右心室的前后负荷回复正常,左心室的解剖构型、舒张和收缩功能迅速得到纠正,血流动力学快速改善,前负荷的变化对心率无影响。     

New-onset migraine with aura after transcatheter closure of atrial septal defect

Transcatheter closure of atrial septal defect (ASD) is associated with a high success rate and become an accepted alternative to surgical treatment. We describe here a case of a 35-year-old woman who presented with migraine attacks with aura after transcatheter closure of ASD with an Amplatzer septal occluder device. We postulate that any of the following may have been responsible for her condition: platelet activation on the surface of the device, nickel allergy, or the release of the atrial natriuretic peptide associated with the stretch of the atrial septum caused by the device. This case demonstrates that de novo migraine can occur after transcatheter closure of ASD and should be recognized as a potential complication.     

Migraine with aura related to closure of atrial septal defects

A 27-year-old woman had a history of migraine with aura (MWA) since aged 13 years with mostly two attacks per year. After transcutaneous closure of a secundum atrial septal defect (ASD) she suffered from almost daily recurring migraine attacks with prolonged aura symptoms. Exacerbation and new appearance of migraine attacks with aura after transcutaneous closure of ASD have been described previously.     

经胸超声心动图在膜周部室间隔缺损封堵术中的应用价值

目的评价经胸超声心动图(TTE)在膜周部室间隔缺损(VSD)封堵术中的应用价值。方法选择我院经导管实施膜周部VSD封堵术的患者21例,年龄5~32岁。TTE用于封堵术前患者的筛选,术中封堵器放置的引导和监测以及术后的随访。结果21例膜周部VSD患者均在TTE引导和监测下成功地完成缺损封堵。术前TTE检查测量缺损直径5~12 mm,平均(6.69±2.21)mm,左心室造影测量缺损直径4~12mm,平均(6.38±2.60)mm,TTE测值与造影测值间差异无统计学意义。术后TTE随访多次未见并发症。结论TTE是一种安全、可靠、有效的检查手段,在膜周部VSD介入封堵术前病例的筛选、术中引导和监测、术后随访中有着其他影像检查无法替代的作用。