成人房间隔缺损外科治疗探讨

成人房间隔缺损（房缺）的手术适应证仍有争论,禁忌证亦不确定。我们回顾５２例成人房缺手术治疗的经验和教训,结合文献对成人房缺手术治疗的有关问题进行探讨如下：临床资料５２例成人继发孔房缺中男２３例,女２９例;年龄１８～２４岁２８例,２５～４７岁２４例。术...     

成人房间隔缺损的外科治疗

本文报告１９８７～１９９４年２１２例成人房间隔缺损的手术治疗，年龄１８～５１岁（平均２７岁）。其中，合并其他心内畸形者４５例，术前出现功能性三尖瓣关闭不全，心律失常或肺动脉高压等合并症者５９例，全组手术无死亡，手术结果表明，成人房间隔缺损，包括合并其他心内畸形或术前出现合并症，但符合手术适应证者均可完全地进行手术矫治。     

下腔型房间隔缺损的外科治疗

下腔型房间隔缺损的外科治疗王维新解士胜郑光明徐金星李令珂李一粟１９８６年１２月至１９９６年１２月我们共手术治疗下腔型房间隔缺损（房缺）４６例，占同期房缺手术的２３％（４６／２０６例），现总结如下：临床资料本组中男２４例，女２２例。年龄３～５２岁，平均...     

成人房间隔缺损的手术治疗

成人房间隔缺损的手术治疗杨国泰，张杰春，许志方１９７４年１月至１９９３年１１月，共收治２０岁以上成人房间隔缺损病人８９例，占同期房缺手术３９７例病人的２２．０４％，无手术死亡病例。临床资料本组８９例中男２３例，女６６例。年龄２０～２９岁６３例，３０～...     

静脉窦型房间隔缺损的外科治疗

目的 总结静脉窦型房间隔缺损（SVASD）外科治疗的方法和经验。方法 32例SVASD患者均伴有右侧部分或全部的肺静脉异位引流。上腔SVASD25例，其中22例采用双片心包补片修补，3例将异位引流的肺静脉改道、上腔静脉与右心耳吻合（Warden法）进行手术纠治。7例下腔SVASD患者中，3例为弯刀综合征，关闭房间隔缺损（ASD）的同时将异位引流的肺静脉离断后与左心房后壁吻合；其余4例采用单片心包补片修补ASD。结果 手术效果满意，无手术死亡。随访28例，心电图检查均为窦性心律；心脏超声心动图检查提示：心内无残余分流、右肺静脉及腔静脉回流无梗阻。结论 SVASD特殊的解剖结构决定了其多伴右侧肺静脉异位引流，纠治上腔SVASD时应注意避免损伤窦房结，防止上腔静脉回流梗阻；但弯刀综合征多伴右肺发育不良，心功能情况还须长期随访。     

多发性房间隔缺损介入治疗

目的本文报告1998年10月-2006年11月13例多发性ASD介入治疗体会。方法13例中男3例,女10例。年龄4~60岁,平均(26.1±4.2)岁。13例中9例2处缺损,3例3处缺损,1例4处缺损。合并房间隔膨出瘤2例,1例合并心房纤颤和心包积液。结果13例中11例应用一个闭合器功闭合,闭合器型号12~40 mm,2例应用两个闭合器闭合缺损,型号均为18/8 mm,2例术后残余分流。无其它并发症。结论多发性ASD介入治疗,必用TEE监测,确定ASD数目、直径和间距,尽量用1个闭合器闭合多处缺损。     

房间隔缺损合并部分肺静脉异位引流外科治疗34例

房间隔缺损合并部分肺静脉异位引流外科治疗３４例王学锋肖颖彬闵家新陈林刘欲团史鉴运褚衍林房间隔缺损（ＡＳＤ）合并部分肺静脉异位引流（ＰＡＰＶＣ）是一种较常见的先天性心脏病。我院在１９８０年１月～１９９６年１月共行ＡＳＤ修补术３７８例，其中合并ＰＡＰＶＣ...     

食管超声引导介入治疗房间隔缺损病人的监护

介入封堵房间隔缺损 (ＡＳＤ)是近年国内外推崇的新技术 ,通常需要经食管超声心动图 (ＴＥＥ)监测ＡＳＤ直径、选择封堵器并协助定位、观测有无残余分流等[1] 。但食管超声探头插入可给病人带来不适 ,尤其于儿童操作不易 ,且有一定危险。娴熟的护理配合、严密的监护是手术全面成功的重要保证。我院 1999年 4月至 2 0 0 1年 12月在食管超声引导下行房间隔缺损封堵术 10 9例 ,取得满意效果 ,其配合与监护报告如下。1　临床资料中央孔型ＡＳＤ 10 9例 ,男 34例、女 75例 ,年龄 2～ 6 0 (2 6 3± 2 3 2 )岁。其中 10 5例有不同程度右房右室增大…     

超声心动图引导下介入治疗房间隔缺损合并严重肺动脉高压

目的 探讨超声心动图监测、配合介入治疗房缺(ASD)合并肺动脉高压(PH)的诊断标准及适应证选择。方法 10例ASD女性患者，均为单一缺损，其中1例患自身免疫缺陷病，1例安置单腔永久起搏器。全部患者术前均作体表超声(TTE)，术中用食管超声(TEE)监测引导介入治疗全过程。结果 10例患者应用AGA-Amplatzer闭合器闭合成功，其中2例采用特制带小孔Amplatzer闭合器，技术成功率达100％。闭合型号为24～40mm。10例无并发症，术后2～3天出院。结论 超声引导下介入治疗ASD合并PH是必不可少的，在介入治疗中起重要作用。     

50岁以上房间隔缺损介入与外科治疗的对比研究

目的　探讨高龄继发孔房间隔缺损 (ASD)病人的最佳治疗方式。方法　收集 5年来 5 0岁以上继发孔ASD行常规外科手术修补 5 3例和同期经导管介入Amplatzer双盘封堵器堵闭ASD 4 2例的资料进行分析 ,两组病例均采用彩色多普勒超声心动图测量心尖四腔心的右室长径、肺动脉压、三尖瓣反流面积、左室舒张末内径 ,左室射血分数等进行对比。结果　外科手术组成功 5 2例 ,成功率 98 1% ,术后出现脑栓塞、心包积液等并发症 13例 ( 2 4 5 % ) ,死亡 1例 ( 1 9% )。导管介入组堵闭成功率 97 6 % ,仅 1例于术后第 4d封堵器脱落移位至肺动脉。两组术后超声心动图复查显示 ,右心室超负荷明显改善 ,右心腔缩小 ,肺动脉高压改善或消失 ;住院天数外科组为 ( 19 8± 12 2 3)d ;介入组 ( 5 0± 2 5 )d。结论　外科手术治疗ASD适应证范围较介入组宽 ,对合并心脏结构明显异常者 ,需行外科手术 ,方可矫正血流动力学异常。介入组术前病例选择非常重要 ,严格掌握适应证范围和尽可能准确地了解ASD的最大直径 ,恰当选择封堵器的大小极为重要 ,经筛选的高龄ASD病人应用经导管介入治疗成功率高、并发症少、疗效好 ,恢复得快。     

复合技术治疗低龄低体重病儿房间隔缺损

目的 介绍一种房间隔缺损(ASD)"复合"技术介入封堵方法,并探讨该手术方法的优缺点.方法 2007年6月至2008年3月,27例婴幼儿房间隔缺损者接受新"复合"技术治疗.其中男15例,女12例.年龄3个月-4岁,平均(2.00±O.22)岁.采用浅镇静加局部麻醉,非气管插管单纯面罩吸氧或喉罩下辅助通气支持,胸骨旁第4肋间小切口,保留胸膜,经胸膜外进入心包腔显露右心房壁,切开右房壁置入ASD封堵器及输送器.心前区或剑突下超声引导进行ASD介入封堵术.结果 全部病儿3d后康复出院,随访0.5-9.5个月,平均(5.9±0.5)个月,仅l例病儿因心包压塞行心包穿刺引流术,余无异常.超声检查没有残余分流或其它并发症.结论 该手术方法创伤小、疗效好,费用低,是婴幼儿ASD病例一种较为理想手术方法.     

Results of surgical closure of isolated secundum atrial septal defect

Methods A retrospective analysis of all patients undergoing surgical closure of an isolated secundum atrial septal defect, at the Postgraduate Institute, Chandigarh between January 1974 and June 2000 was performed. 740 patients were divided into two groups. Group I. Included 435 patients under 20 yrs of age (223 male), 315 (72%) were asymptomatic, 265(61%) were in sinus rhythm. Group II. included 305 patients between 21 and 53 years (96 males), 27 patients (9%) were asymptomatic, 102(33%) were in sinus rhythm. Cardiopulmonary bypass with fibrillatory arrest and/or cold blood cardioplegia were used. In group I 291 patients (67%0 and in group II 64 patients (54%) underwent direct closure of the defect. In the remaining a patch was used for closure. Results There was 1 early death in group I (0.2%) and four in group II (1.3%) 96% of symptomatic patients in group I and 87% of patients in group II were improved. There were no instances of residual shunt. Follow up ranged from 6 months to 25 years (mean 8.3 yrs) and was 89% complete. Conclusions Closure of isolated secundum ASD is best performed before the patient attains adulthood.     

超声心动图在经导管房间隔缺损封堵术中的应用

经导管介入封堵术是治疗房间隔缺损(atrial septal defect,ASD)的重要方法。超声心动图不仅能指导选择封堵器型号,而且可在术前筛查、术中监测及术后复查中发挥重要作用。本研究探讨超声心动图在ASD经导管封堵治疗过程中的应用价值。1资料与方法1.1研究对象2011年10月—     

小婴儿巨大室间隔缺损的外科治疗

目的 报告３９例出生６个月以内小婴儿巨大型空间隔缺损的外科治疗经验。方法 体外循环下除４例经肺动脉切口外其余均经右房切口,行补片缝合修补空间隔缺损。其中合并动脉导管未闭５例、房间隔水平分流１２例和右室流出道狭窄２例均同期矫治。结果 ３９例病儿均痊愈出院。结论 巨大型空间隔缺损的小婴儿出现顽固性心力衰竭、药物治疗无明显效果或生长发育停滞及肺动脉高压时即应手术。尽可能完善的围术期处理是降低病死率的重要     

Amorphous cardiac tumor of right atrium late after atrial septal defect closure

We describe an unusual case of calcified cardiac mass in a patient seventeen years after Dacron patch closure of atrial septal defect. Presenting symptom was prolonged fever and after surgical excision the patient remains afebrile at one year of follow up. The clinical course and histopathological features were consistent with cardiac calcified amorphous tumor (cardiac CAT) Amorphous cardiac tumors are rare non-neoplastic cardiac masses, which are often indistinguishable clinically from true neoplasms. The surgical excision of these tumors is curative and recurrence is unknown.     

全机器人心脏不停跳下房间隔缺损修补术

目的 总结使用"达芬奇S"(da Vinci S)机器人手术系统,心脏不停跳下房间隔缺损修补或房间隔缺损修补+三尖瓣成形术的经验体会.方法 2009年3月至2010年12月,使用da Vinic S机器人系统,心脏不停跳下完成继发孔型房间隔缺损修补或房间隔缺损修补+三尖瓣成形术40例.患者女23例,男17例;年龄平均(38±13)岁.房间隔缺损直径为1.5～3.5 cm,平均(2.8±1.3)cm,无右向左分流,伴有或不伴有三尖瓣重度关闭不全.手术经股动、静脉及右侧颈内静脉插管建立体外循环.于右侧胸壁打直径为0.8 cm的器械臂孔3个,直径为2 cm工作孔1个,术中不阻断升主动脉,经内窥镜套管持续给予二氧化碳,心脏跳动下,术者于操作台前遥控机器人进行房间隔缺损修补,三尖瓣重度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损22例,心包补片修补房间隔缺损18例,同期三尖瓣成形9例.术中食管超声评估修补及三尖瓣成形效果.对比不停跳与心脏停跳下全机器人房间隔缺损修补术的手术时间及体外循环时间.结果 所有患者均成功接受全机器人心脏不停跳下房间隔缺损修补术或房间隔缺损修补+三尖瓣成形术,无体循环气体栓子及残余分流等并发症.不停跳组的手术时间、机器人使用时间或体外循环时间少于停跳组.结论 机器人心脏不停跳下房间隔缺损修补术无需阻断升主动脉,简化了全机器人手术过程,手术效果安全可靠.

Abstract：

Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using "da Vinci S" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using "da Vinic S" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After "da Vinci S" syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely.     

Surgical closure of atrial septal defect

Background: Closure of ostium secundum atrial septal defect (ASD) vis median sternotomy (MS) is a simple procedure for most cardiac surgeons. Minimally invasive cardiac surgery (MICS) has recently been applied in the management of intracardiac lesions. Methods: We report our experience in surgical closure of isolated ASD via MICS in 60 patients and via MS in 58 patients. There was no difference between these two groups in gender, age, body weight, ratio of systemic to pulmonary blood flow, and pulmonary arterial pressure. Results: The duration of cardiopulmonary bypass was significantly longer in the MICS group than in the MS group [27 to 126 min (42 ± 12) and 14 to 158 min (27 ± 11), respectively; (p < 0.001]. However, the length of incision, incidence of temporary pacemaker wire insertion rate, duration of endotracheal intubation, timing of oral intake, postoperative day drainage amount, incidence of parenteral analgesic injection, postoperative length of stay, and return to normal activity interval were significant shorter and lower in patients of the MICS group than in those of the MS group. All the patients recovered rapidly from the surgery. Follow-up was complete in all patients, with no late complications and no residual shunt. Conclusion: Our results suggest that MICS is a good option for surgical closure of ASD. Received: 4 June 1997/Accepted: 29 October 1997     

Migraine-like headaches associated with nickel allergy requiring removal of atrial septal defect closure device

There is a deficit of literature regarding the association between nickel allergy–induced symptoms and implanted devices. This report describes a case of nickel allergy causing debilitating migraine-like symptoms, failing to resolve with medical therapy, requiring surgical removal of the device and repair of the defect.