血管腔内介入治疗下肢动脉硬化闭塞症40例

目的：探讨下肢动脉硬化闭塞症腔内治疗的临床经验。方法：采用血管腔内介入方法治疗下肢动脉硬化性闭塞症（ASO）患者40例（44条肢体）,包括髂动脉病变18例,其中单纯球囊扩张术（PTA）6例,内置支架术（PTA＋stenting）12例;股浅动脉病变13例,其中PTA5例,PTA＋stenting8例;腘动脉病变2例,行PTA治疗;膝下动脉病变7例,单纯deep球囊扩张,不放置支架。结果：本组无手术死亡。髂动脉18例手术全部获得成功;股浅动脉13例,11例获得成功,1例致血栓形成取栓治疗成功,1例介入失败转为人工血管转流手术;腘动脉2例获得成功;膝下动脉7例中5例获得成功。结论：血管腔内介入治疗下肢ASO,操作简单,短期效果良好,值得临床推广应用;     

膝以下动脉硬化闭塞症的介入治疗

目的：探讨膝以下动脉硬化闭塞症腔内治疗的方法、难点、并发症处理以及预后。方法：2008年1月至2011年12月,采用介入方法治疗膝以下动脉硬化闭塞症72例（84条肢体）。采取股总动脉顺行或逆行穿刺,下肢动脉造影,以导丝配合导管通过动脉狭窄段,或开通动脉闭塞段;开通失败者,尝试内膜下血管成形术;经导丝引入球囊进行扩张,扩张完毕后造影,如残余狭窄＞30％,则再次扩张;出现动脉夹层者,行药物洗脱支架植入。结果：84条肢体行介入治疗,82条肢体获得影像学成功,技术成功率为97．6％。术后16例间歇性跛行患者跛行距离平均增加500 m（50～2500 m）,43例静息痛者疼痛均减轻或消失,8例足趾溃疡者经换药3个月内溃疡全部愈合,1例足趾溃疡患者因介入术后支架内血栓形成而行股-腘动脉自体大隐静脉原位转流术。3例足趾坏疽者行截趾术,术后3个月内创口愈合。1例前半足坏疽者行膝下截肢。术后6个月、1年肢体通畅率分别为96．3％和95．0％,术后1年肢体保全率为95．0％。结论：对于膝以下动脉狭窄或闭塞性病变者行腔内治疗,成功率高、效果明显、并发症少、保肢率高、可重复治疗,是安全有效的治疗方法。     

改良游离下腹部穿支皮瓣修复手部创面

目的探讨改良游离下腹部穿支皮瓣修复手部创面的临床应用效果。方法采用以腹壁浅动脉、旋髂浅动脉为蒂的深筋膜穿支皮瓣修复手部创面43例。其中以旋髂浅动脉为蒂的皮瓣修复20例,以腹壁浅动脉为蒂的皮瓣修复23例。皮瓣面积8cm×5cm～22cm×11cm。观察术后皮瓣成活情况。结果术后42例皮瓣全部成活,1例皮瓣术后坏死,经换药后瘢痕化愈合,不影响手部功能。所有皮瓣经4—18个月（平均10个月）随访,皮瓣质地外形优良,手功能恢复满意。术后供区伤口均一期愈合,外形满意。结论应用改良的游离下腹部穿支皮瓣修复移植修复手部创面,克服血管变异、口径小等不足,皮瓣成活率显著提高,是一种较好的方法。     

Morphological features of blood access stenosis and results of noninvasive angioplasty

We investigated a connection between the results of noninvasive angioplasty for the blood access stenosis and its morphological features in 37 dialysis cases. In 3 cases presenting stenosis in the original artery, the area could not be dilated by noninvasive techniques. In 4 cases with stenosis in the arterialized vein downstream of the needle insertion points for extracorporeal circulation, 3 showed long-term dilatation by the procedures. In 30 cases having stenosis upstream of the points, 16 showed long-term dilatation. In the unsuccessful cases, the angle formed between the axes of the stenosed portion and the normal vessel was over 39 degrees, and the distance between the anastomosis and the stenosed portion was less than 11 mm.     

肾移植及移植后的血管并发症

背景：尽管肾移植手术技术已相当成熟,但各移植中心难免会出现术中及术后的血管并发症。 目的：分析肾移植过程中及移植后血管并发症的诊断与处理。 方法：回顾性分析 11 例肾移植过程中、移植后血管并发症资料。移植过程中并发症：动脉吻合口狭窄2例,肾静脉横断1例,髂外动脉硬化斑块剥脱堵塞肾动脉3例,移植肾静脉扭曲1例;移植后并发症：肾外型假性动脉瘤2例,吻合口狭窄1例,移植肾动脉压迫梗阻1例。 结果与结论：肾移植中吻合口狭窄2例移植后恢复良好,分别于移植后6年及11年移植肾失功;肾静脉横断1例随访12年移植肾失功;髂外动脉硬化斑块剥脱堵塞肾动脉3例,1例移植肾当即失功,另2例分别随访6年及2年,现移植肾功能良好;移植肾静脉扭曲1例移植后出现移植肾功能延迟恢复,1个月后因重症肺部感染死亡。移植后发生的血管并发症中肾外型假性动脉瘤2例移植肾均失功;吻合口狭窄1例经置入支架后肾功能恢复正常,已随访18个月;移植肾动脉压迫梗阻1例移植后出现移植肾功能延迟恢复,3周后因重症肺部感染死亡。结果说明肾移植过程中及移植后发生血管并发症,只要诊断准确、处理及时,可取得比较满意的治疗效果。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

冠状动脉造影和三磷酸腺苷负荷超声心动图对川崎病冠状动脉损害远期追踪的价值

目的探讨选择性冠状动脉造影及三磷酸腺苷负荷超声心动图对川崎病（KD）冠状动脉损害远期追踪的价值。方法选取1999至2007年广州市儿童医院KD急性期超声心动图检查发现合并冠状动脉损害的患儿,同时采用三磷酸腺苷负荷超声心动图及选择性冠状动脉造影于恢复期进行远期随访。结果依据纳入标准和排除标准逐层筛选,确定9例KD患儿为本研究的样本。男8例,女1例,急性期发病年龄为1-10岁,平均（4.44±3.09）岁。检查时年龄4-12岁,平均（7.89±2.62）岁。追踪时间1.5~7年,平均（3.44±1.67）年。急性期超声心动图示9例患儿中冠状动脉巨瘤5例,冠状动脉瘤3例,冠状动脉扩张1例。三磷酸腺苷负荷超声心动图示：节段性室壁运动异常6/9例;冠状动脉血流储备下降5/9例。冠状动脉造影示：双侧主干冠状动脉瘤4例,同时伴远端动脉瘤3处,冠状动脉左前降支狭窄1处,并冠状动脉扭曲,狭窄或充盈缺损3处,附近侧支血管形成1处;左前降支动脉瘤、右冠状动脉闭塞伴侧支循环形成1例,冠状动脉扩张4例。与同期超声心动图检查比较,冠状动脉造影新发现冠状动脉远端瘤3处,右冠状动脉远端狭窄2处,左前降支狭窄1处,右冠状动脉闭塞伴侧支血管形成1例。5例三磷酸腺苷负荷超声心动图检查结果阳性者与冠状动脉造影比较：均发现相应冠状动脉支狭窄或充盈缺损表现;1例三磷酸腺苷负荷超声心动图检查结果阳性,冠状动脉造影仅见轻度冠状动脉扩张。结论KD合并冠状动脉损害特别是动脉瘤造成的心脏损害可长期存在。对于远期追踪观察KD患儿冠状动脉病变,三磷酸腺苷负荷超声心动图具无创、安全可靠的优点,是判断心肌缺血的重要方法;选择性冠状动脉造影可明确显示冠状动脉病变的位置、形态、数目及严重程度,特别对冠状动脉狭窄、闭塞及远端病变能做出准确的评估。两种方?     

About the arterial blood vessels pelvic opossum's (Didelphis albiventris) behaviour

The work consists of the study of 20 opossums (Didelphis albiventris); 7 females and 13 males, adults, natives of Jaboticabal county proceeding to a cannulation and injection of the arterial system with neoprene latex-650 in the aorta artery (full-blooded). Right away the preparations were fixed by a 10% formaldehyde aqueous solution and afterwards dissected and formed a scheme. The analysis of the pieces showed that in the opossum, the end of the aorta always divides in the common iliac artery, right and left sides, both originating the external and internal iliac artery, on the right and left sides. The medium sacral artery results, medianly, from the aorta division's angle in 2 common iliac arteries in 8 cases (40%-6 males and 2 females); this vessel comes from the left common iliac artery in 7 animals (35%-5 males and 2 females) or comes from the right common iliac artery, in 5 preparations (25%-3 females and 2 males). The deep iliac circumflex artery is born by the common iliac artery from the right side in 10 preparations (50%-6 males and 4 females); can appear as well, concomitantly with the external and internal iliac artery, from the right side in 9 pieces (45%-6 males and 3 females) and further from the right this vessels can emerge from the external iliac artery, in 1 case only (5%-1 male).     

CDUS与A/BI联合检测对慢性下肢动脉闭塞症的应用价值

目的以彩色多普勒超声（CDUS）与踝／肱指数（A／BI）联合检测，对下肢慢性动脉闭塞疾病的诊断及对治疗前、后评价的价值。方法以下肢动脉血管造影确诊的120条动脉硬化性闭塞症（ASO）和血栓性脉管炎（TAO）60条为标准，用以确定CDUS检测的阳性诊断率，并加以分析：同时对180条下肢动脉的踩肱指数和89条下肢动脉闭塞症的术前、术后踝／肱指数变化予以测定并进行比较。结果CDUS检查结果与动脉血管造影（PAG）检查结果无显著差异，CDUS与A／BI联合检测对提高诊断率有较高准确性。A／BI测定对了解术前及术后供血有否改善提供重要参考依据。结论彩色多普勒超声检查与踝／肱指数测定是对ASO和ATO诊断及评价治疗效果、术后复查的首选方法。     

一期开放手术加升主动脉-双髂外动脉旁路术治疗主动脉缩窄合并其他心脏疾病效果观察

目的 评价主动脉缩窄(CoA)合并其他心脏疾病患者在开放心脏手术同期行升主动脉-双髂外动脉旁路手术的治疗效果。方法 回顾性分析2010年3月—2014年7月阜外医院血管外科收治的36例CoA合并其他心脏疾病患者的临床资料。其中男24例,女12例;年龄25～63岁,平均39岁;上肢收缩压165 mmHg(1 mmHg=0.133 kPa),上下肢压差51 mmHg。36例患者均在开放心脏手术同期使用Y形人工血管行升主动脉-双髂外动脉旁路术治疗,其中主动脉瓣替换8例,室间隔缺损修补6例,Bentall′s术15例,Wheat′s术7例。术后观察手术时间、术中出血量、重症监护治疗病房留观时间、住院时间、术后并发症发生情况、术后上肢血压和上下肢压差,以及术后早期病死率、术后人工血管通畅率及再手术率。对手术前后上肢收缩压及上下肢压差进行配对t检验。结果36例患者均顺利完成手术,手术时间129～223 min,平均144 min;术中出血量250～700 mL,平均400 mL;重症监护治疗病房留观时间18～43 h,平均35 h;住院时间9～15 d,平均11 d。术后早期无死亡病例,无肾功能不全等并发症。术后第5天1例患者右侧人工血管血栓形成,其余患者人工血管血流通畅。术后第5天上肢收缩压(132±26)mmHg,上下肢平均压差(10±3)mmHg,均较术前明显降低,差异均有统计学意义(t=2.322、3.193,P值均＜0.05)。术后36例患者均获随访,随访时间3～55个月,平均27个月。随访期间无一例死亡,上肢收缩压110～135 mmHg,上下肢压差5～12 mmHg,治疗有效率100%,无外科再干预。术后6～12个月行主动脉CTA复查,35例患者双侧人工血管血流通畅;1例术后即出现人工血管血栓形成的患者,随访期间血栓无明显变化,无新发血栓形成。结论 CoA合并心脏疾病患者在开放心脏手术同期行升主动脉-双髂外动脉旁路术,简化了手术操作,减少了手术创伤,安全有效,是治疗CoA合并心脏疾病的一种选择。     

血管内支架治疗鼻咽癌放疗后颈部血管狭窄或闭塞病变的效果

目的探讨血管内支架置入术治疗鼻咽癌放疗后的颈动脉狭窄或闭塞病变的疗效。方法对3例鼻咽癌患者放疗后出现严重动脉狭窄或闭塞病变的颈部血管行球囊成形术及支架置入术并进行随访。结果 3例患者均为男性,其中1例为双侧颈动脉闭塞,进行了一侧颈动脉闭塞病变再通术;1例为双侧颈动脉重度狭窄,进行了左侧颈动脉支架成形术;1例右颈内动脉起始段严重狭窄,左侧颈动脉闭塞,对右侧颈动脉严重狭窄处进行了血管内支架治疗;经过随访并未发现有支架内再狭窄。结论血管内支架置入术是治疗鼻咽癌放疗后颈部血管重度狭窄或闭塞病变的有效手段。     

Bilateral persistent complete sciatic artery

A case with persistent sciatic artery (PSA) was found in a cadaver of a 65-year-old female during a medical gross anatomy course. The artery was bilateral and complete and provided the major blood supply to both lower extremities. The vessel arose from the internal iliac artery that was extremely large bilaterally. The sciatic artery passed out of the pelvis through the infrapiriform foramen and descended posterior to the sciatic nerve through the gluteal region. The sciatic nerve was considerably flattened out under the artery. Large articular branches arose from the part of the artery at the buttock just below the piriform muscle. The artery descended along the back of the thigh and was crossed obliquely posteriorly by the long head of the biceps femoris muscle. The sciatic artery continued as the popliteal artery located very superficially in the popliteal fossa. A companion vein, i.e., the sciatic vein, accompanied each artery. The right sciatic vein entered the pelvis posteriorly through the infrapiriform foramen, whereas the left perforated the quadriceps muscle from behind and joined the femoral vein anteriorly. There was a gracile superficial femoral artery bilaterally. The deep femoral arteries of both lower limbs were hypoplastic with slender circumflex branches. There were no macroscopic connections between the sciatic and the deep or superficial femoral arteries on either side. This anomaly should be kept in mind in the evaluation of patients with sciatic or buttock pain or palpable "pulsating" buttock mass. Persistent sciatic artery also could be a potential hazard during orthopedic manipulations, hip joint surgery, and renal transplant surgery.     

Prevalence and severity of atherosclerosis in renal artery in Northwest Indian population: an autopsy study

Background  Atherosclerosis has been described as the most common cause of renal artery stenosis. The purpose of this autopsy study was to assess the preponderance and severity of atherosclerotic changes in renal artery in different age groups in normal population. Methods  Ninety renal arteries from 45 cadavers above 30 years of age were obtained at autopsy. Fifty-four renal arteries were studied grossly after Sudan IV staining for extent and severity of fatty deposits in terms of Atherosclerotic index (AI). Another 36 renal arteries were studied microscopically for changes in different layers and at different sites of artery and luminal narrowing, if any with advancing age. Results  In grossly stained specimens, incidence and AI which is the marker of extent and severity of lesions were found to increase gradually with advancement of age. Increased incidence of atherosclerotic changes with better nutritional status was recorded. In microscopically studied specimens, intimal thickness which is a marker of disease also showed upward rise with advancing age. Renal artery stenosis was prevalent in 13.8% cases. Lesions were most commonly detected at renal ostium and proximal segment. Conclusions  Fatty changes appear with advancing age. Advanced types of changes including fibrous plaques, calcification and ulceration were noticed first in fifth decade. The changes were usually bilateral. Proximal segment was the most affected part. Four cases had less than 50% and one case had 70% luminal narrowing. The changes were only moderately severe in most of the cases.     

髂腹股沟穿支皮瓣移植修复四肢皮肤软组织缺损

目的　总结应用移植髂腹股沟穿支皮瓣修复四肢皮肤软组织缺损的临床疗效。 方法　对29例伴有深部组织外露或骨缺损的四肢皮肤软组织缺损病例,采用髂腹股沟穿支皮瓣进行移植修复,其中采用旋髂浅动脉穿支皮瓣修复8例;采用旋髂深动脉穿支皮瓣修复4例;采用腹壁浅动脉穿支皮瓣修复8例;采用旋髂深动脉嵌合髂骨穿支皮瓣修复3例;采用髂腹股沟联体穿支皮瓣修复6例。皮瓣最小面积5.0 cm×6.0 cm,最大面积35.0 cm×15.0 cm。皮瓣供区均直接缝合。 结果　术后移植皮瓣全部成活,2例发生皮瓣皮下血肿压迫出现动脉供血障碍,拆除部分缝线后血运恢复,1例发生静脉血管危象,经手术探查后恢复血运。 22例获得随访,随访时间为1~24个月,平均5个月。皮瓣质地柔软,外观较平坦,两点分辨觉10.0～20.0 mm。受区移植髂骨均生长良好,骨折完全愈合。供区见2例瘢痕稍增生,余均呈线状瘢痕愈合良好。 结论　移植髂腹股沟穿支皮瓣具有供区隐蔽,可直接缝合,不损伤主干动脉等传统优点,且具有可灵活修复骨缺损,可切取大面积联体（嵌合）穿支皮瓣及可修薄等特点,是修复四肢软组织缺损较为理想的方法。     

脑卒中患者的无创动脉硬化检测指标与颅内、外动脉狭窄相关性分析

目的：探讨脑卒中患者无创动脉硬化检测各项指标与颅内、外动脉狭窄发生率的相关性.方法：分别对340例脑卒中患者进行无创动脉硬化检测及经颅多普勒（TCD）检测,将动脉硬化检测各项指标与TCD发现一条以上颅内、颅外动脉狭窄者比较.结果：运用非条件Logistic回归分析显示,小动脉顺应性（C2）似然比检验P＜0.05,差异有统计学意义.结论：小动脉顺应性（C2）异常是导致颅内、外动脉狭窄的独立危险因子 。     

动静脉转流术在下肢动脉硬化闭塞症中的作用

目的 探讨动静脉转流术治疗下肢动脉硬化闭塞症，研究其技术操作及临床应用。方法 对6例下肢动脉硬化闭塞症患者行Guo动脉胫后静脉转流术。结果 疗效优良5例，好转1例，术后只有一足趾截法。结论 此方法不易导致心衰，可挽救缺血肢体，避免截肢，疗效满意。     

肾移植后血管并发症介入治疗8例*☆

背景：肾移植后血管并发症采用介入治疗已成为一种安全有效的治疗方法。 目的：探讨肾移植后血管并发症介入治疗的经验及价值评估。 方法：回顾性分析8例肾移植后血管并发症患者介入治疗的临床资料。 结果与结论：8例移植后5例肾移植肾动脉狭窄,2例假性动脉瘤,1例肾静脉血栓,均经彩色多普勒血流显像作出初步诊断,其中5例进一步行磁共振血管成像明确诊断。5例移植肾动脉狭窄行球囊扩张,分别随访6,8,20,36,40个月,1例出现再狭窄,随访血肌酐维持在130~160 μmol/L之间,其余4例移植肾狭窄无复发,随访血肌酐均正常。2例假性动脉瘤患者经动脉鞘放入支架释放系统释放带膜支架后动脉瘤消失,目前常规血液透析治疗。1例肾静脉血栓形成患者,尿激酶介入溶栓治疗后血栓消失,患者发生移植肾功能延迟恢复,35 d后血肌酐降至210 μmol/L,此后患者血肌酐维持在200~250 μmol/L。8例介入治疗临床效果说明肾移植后血管并发症治疗可选用介入治疗方法。 关键词：血管并发症;介入治疗;肾移植;肌酐;器官移植 doi:10.3969/j.issn.1673-8225.2012.05.044     

Surgical repair for abdominal aortic aneurysm concomitant with iliac arterial disease using InterGard? Quadrifurcated

InterGard? Quadrifurcated [InterVascular S.A. (MAQUET Cardiovascular), La Ciotat, France], a knitted quadrifurcated prosthetic graft, is useful to simplify the procedures for patients with abdominal aortic aneurysm concomitant with iliac arterial disease. From March 2008 to April 2010, 59 patients underwent abdominal aortic aneurysm repair in our department. InterGard? Quadrifurcated was used in 22 patients (37.3%). All patients were male with a mean age of 72.1 ± 12.1 years (range from 45 to 90 years). Four were emergency cases. Nineteen patients had common iliac arterial lesions, and 19 patients had internal iliac arterial lesions. In addition to abdominal aortic aneurysm repair, reconstruction of bilateral internal iliac arteries was performed in 4 patients, reconstruction of unilateral internal iliac artery in 15 (right 6, left 9), and internal mesenteric artery in 13. There was one hospital death due to nonocclusive mesenteric infarction. There were two complications, which were intestinal perforation and intestinal obstruction. All of these three cases were emergency cases. Computed tomography scan 1 week after operation showed that all reconstructed grafts were patent. Although patients with abdominal aortic aneurysm concomitant with iliac arterial disease had many preoperative comorbidities, surgical results with InterGard? Quadrifurcated were satisfactory. It is useful to simplify the procedures for these patients.     

股腘动脉人工血管旁路术中膝周肌瓣构建侧支血管在下肢动脉硬化闭塞症治疗中的应用与观察

目的 探讨股腘动脉人工血管旁路术中膝周肌瓣构建对下肢动脉硬化闭塞症（ASO）患者术后人工血管闭塞后膝下血供的代偿作用。方法 回顾性描述性研究。选取皖南医学院附属弋矶山医院血管外科2012年6月—2020年7月ASO患者31例,其中男22例、女9例,年龄52~87（72.3±3.6）岁。均为单侧肢体病变,左侧14例、右侧17例,Rutherford分期3级以上,踝肱指数（ABI）为0.32±0.13。均行股腘动脉人工血管旁路术治疗,术中将离断的腓肠肌内侧头与同侧的半膜肌、半腱肌及缝匠肌瓦合叠加缝合,以膝周肌瓣构建侧支血管。术后,在超声检查人工血管闭塞（无血流信号）后,观察患者肢体缺血情况,同时观察并比较患者手术前后ABI;出院时按照Rutherford标准评价患者手术疗效;随访期间观察并统计患者截肢率,观察成功保肢患者的生活状态。结果 31例患者手术均顺利完成,无围术期死亡患者。术后1周ABI为0.58±0.19,高于术前的0.32±0.13,差异有统计学意义（t=3.02, P=0.002）。出院时手术疗效评价：显著有效15例、有效10例、无效4例、恶化2例。术后随访6~60个月,平均24.6个月。患者在人工血管闭塞后,下肢虽有一过性疼痛、发凉等缺血症状,但经抗凝治疗症状缓解。术后2、24个月分别有1例患者死于心肌梗死,术后3年1例死于脑梗死,生前均无下肢静息痛症状,可作室内活动;2例因股深动脉多节段闭塞、膝下组织血供不足,分别于术后6、15个月行截肢术,余26例患者成功保肢,随访6个月~5年,均无需行临床再干预,均无静息痛。结论 股腘动脉旁路术治疗的ASO患者,采用腓肠肌肌瓣在膝周构建侧支血管,在人工血管闭塞后,下肢缺血无明显加重,说明肌瓣构建对缓解患者膝下肢体缺血状态有一定的作用。     

完全性大动脉错位动脉转位术后新主肺动脉发育的随访

目的报道应用动脉转位术（ASO）治疗完全性大动脉错位（TGA）术后超声心动图的随访结果,评价TGA术后主、肺动脉的发育情况。方法以2001年3月至2007年3月于复旦大学附属儿科医院心血管中心实施ASO治疗TGA术后存活患儿作为研究对象,于2008年8～9月进行随访,行超声心动图检查,测定新主动脉根部内径、新主动脉瓣环内径、新肺动脉内径和新肺动脉瓣环内径,获取的数据与正常参考值做比较。结果研究期间ASO治疗TGA患儿共72例,术中死亡6／72例（8．3％）,存活率为91．7％。失访10／66例,有效数据56例,其中室间隔完整的完全性TGA（TGA／IVS）32例,完全性TGA合并室间隔缺损（TGA／VSD）24例。随访距手术18—168（86．46±23．51）个月。新主动脉根部内径为（16．97±2．71）mm（t=6．936,P〈0．001）,12／56例（21．4％）〉正常参考值90％CI的上限,44／56例（78．6％）在正常参考值90％CI内,平均Z值为1．10±0．70。新主动脉瓣环内径为（16．27±2．38）mm（t=4．52,P〈0．001）,56例均在正常参考值90％CI内,平均Z值为0．66±0．65。新肺动脉内径为（14．29±1．92）mm（t=-3．2,P=0．005）,40／56例（71．4％）在正常参考值90％CI内,16／56例（28．6％）〈正常参考值90％CI的下限,平均Z值为-0．95±1．33。新肺动脉瓣环内径为（14．00±1．92）mm（t=0．132,P=0．897）,42／56例（75．0％）在正常参考值90％CI内,14／56例（25．O％）〈正常参考值90％CI的下限,平均Z值为0．05±1．85。16／56例（28．6％）存有主动脉瓣轻度反流,均为TGA／VSD病例,平均随访（46．0±22．2）个月;40／56例（71．4％）未见主动脉瓣反流,平均随访（46．8±25．3）个月,两组随访时间差异无统计学意义（P=0．899）。随访中未见主动脉狭窄病例。肺动脉瓣上狭窄7／56例（12．5％）,2／56例（3．6％）为轻度狭窄,5／56例（8．9％）为极轻度狭窄。结论目前在复旦大学附属儿科医院心血管中心开展ASO治疗TGA术后新主动脉根部和瓣环内径均有所扩张,新肺动脉根部内径有所缩减,但其瓣环发育良好。主动脉瓣反流常见于TGA／VSD病例,但其反流程度较轻。肺动脉瓣上狭窄是TGA术后常见的并发症,但大多数病例狭窄程度极轻。     

Percutaneous Retrieval of Embolized Amplatzer Septal Occluder after Treatment of Double Atrial Septal Defect: A Case Report

Embolization of the occlusion device after percutaneous closure of atrial septal defect (ASD) is a potential disastrous complication. The usual site of embolization is the right side of the heart including pulmonary artery, but the device embolization to the extracardiac aorta is extremely rare. Here, we report a successful percutaneous retrieval case of the embolized Amplatzer Septal Occluder (ASO) to the descending thoracic aorta after the successful deployment of two ASO devices in a patient with double ASD. Competition between the two devices to obtain a stable position may be an explanation for the migration of ASO.