用Sideris钮扣式补片介入闭合多发性房间隔缺损一例

１ 临床资料 患者,男,４０岁,因房间隔缺损（ＡＳＤ）入院。体检肺动脉瓣区收缩期杂音Ⅲ／６级,Ｐ２亢进分裂。Ｘ线胸片肺血多,右心大,肺动脉段突出。心电图示窦性心律,电轴右偏（＋１５３度）。心脏彩色超声示房间隔有多处回声中断,较大的３处分别为１１　ｍｍ、１２　ｍｍ和８　ｍｍ,跨度３１～３３　ｍｍ。２００１年４月２８日行ＡＳＤ介入闭合术。术中长鞘经中央ＡＳＤ至左心房,置入Ａｍｐｌａｔｚｅｒ　３６　ｍｍ　ＡＳＤ封堵器,拟撕裂各ＡＳＤ间隔,使其融合。但封堵器“腰部”被ＡＳＤ约束,两侧盘片呈球状膨胀。遂将封…     

经皮导管Amplatzer封堵器治疗房间隔缺损

一、材料与方法１．材料１９９８年８月至１９９９年３月,经食管超声心动图（ＴＥＥ）筛选中央型房间隔缺损（ＡＳＤ）１５例;男５例,女１０例,年龄１６～６５岁;ＴＥＥ测缺损最大径（２３．３４±３．２２）ｍｍ,术中球囊测缺损延伸直径（２６．１６±３．３６）ｍｍ。肺动脉压正常５例,轻度升高５例,中度升高３例,重度升高２例。选用美国ＡＧＡ公司制造的Ａｍｐｌａｔｚｅｒ房间隔封堵器,其材料结构是强记忆性的镍钛合金线编织成的双盘网状结构,双盘及腰部铺上海绵状高分子聚合材料。２．方法局麻下穿刺右股静脉,建立股静脉→…     

双腔右心室的术前与术中诊断对比分析

对１７ 例双腔右心室（ＤＣＲＶ） 患者于术前行经彩色多普勒血流显像（ＣＤＦＩ） 检查, 诊断为单纯ＤＣＲＶ４ 例, ＤＣＲＶ 合并室间隔缺损 （ＶＳＤ） ８ 例、肺动脉瓣狭窄 （ＰＳ） １ 例、房间隔缺损（ＡＳＤ） １ 例, 单纯ＶＳＤ２例, 法乐氏四联症１ 例。均经手术治疗, 术中确诊为单纯ＤＣＲＶ４ 例, ＤＣＲＶ合并ＶＳＤ１１ 例、ＡＳＤ１例、ＰＳ１ 例。认为ＣＤＦＩ对ＤＣＲＶ的诊断有较高的准确性, 但对不典型ＤＣＲＶ的诊断仍有一定困难。     

房间隔缺损2例误诊分析

房间隔缺损２例误诊分析鞍山市中心医院心内科（１１４００１）王彦，郑义中国医科大学第一临床学院循环内科傅勇，石玛丽房间隔缺损（ＡＳＤ）是先天性心脏病（先心病）中最常见的一种，占先心病的２１．４％，居首位［１］。典型的ＡＳＤ并不难诊断，并存其它缺损的病例...     

乳梨醇对亚临床性肝性脑病的疗效观察—随机双盲临床试验

目的：评估乳梨醇（Ｌａｃｔｉｔｏｌ）治疗亚临床性肝性脑病的疗效和安全性。方法：３１例亚临床性肝性脑病病人随机分为两组，治疗组１６例，对照组１５例。双盲法分别给予４０％乳梨醇溶液０．５５－１．７５ｍｌ·ｋｇ￣（－１）·ｄ￣（－１），平均１．０５ｍｌ·ｋｇ￣（－１）·ｄ￣（－１）１日３次，以获得每天１－２次软便，及安慰剂５％葡萄糖１０ｍｌ，１日３次，均连续服用２周。服药前后分别行数字连按试验（ＮＣＴ）、数字符号试验（ＤＳ），体表感觉诱发电位（ＳＳＥＰ）及血氨检查，并随访有无临床肝性脑病发生。结果：乳梨醇能有效降低血氨，改善ＮＣＴ、ＤＳ，缩短ＳＳＥＰ的Ｎ２、Ｐ２、Ｎ３、Ｐ３潜伏期。Ｎ１－Ｐ３、Ｎ１－Ｎ３峰间潜伏期，且副反应小。结论：乳梨醇是一种安全，有效的亚临床性肝性脑病的治疗药物。     

国产封堵器治疗房间隔缺损合并肺动脉高压的临床评价

目的 :评价国产心内异常通道封堵器治疗继发孔型房间隔缺损 (ＡＳＤ)合并中重度肺动脉高压 (ＰＨ)的临床疗效。方法 :采用国产器材对 2 0例 (男 5例 ,女 15例 )年龄 3～5 4岁 (平均 38 4岁 )ＡＳＤ合并中重度ＰＨ实施封堵治疗。其中单一ＡＳＤ 19例 ,中央型 18例 ,偏上型 1例 ,2处ＡＳＤ 1例。ＡＳＤ直径 15～ 2 9ｍｍ。肺动脉压力 40～ 92 / 2 6～ 6 2ｍｍＨｇ ,无右向左流。结果 :全组 2 0例ＡＳＤ封堵均获成功。手术在食道超声心动图 (ＴＥＥ)的引导下进行 ,使用球囊测量ＡＳＤ直径 ,结合ＴＥＥ资料 ,选择比ＡＳＤ直径大 2ｍｍ封堵器试封…     

带阀门内支架在动脉导管末闭介入治疗中的应用

目的 评价带阀门内支架在动脉导管未闭（ＰＤＡ）介入治疗中的疗效和安全性。方法 ２２例ＰＤＡ患，年龄３￣５３岁，女性１７例，男性５例。ＰＤＡ内径（最狭处）１．４￣１１ｍｍ，平均５．２ｍｍ，主动脉端内径（最宽处）２．１￣１２ｍｍ，平均７．１ｍｍ；ＰＤＡ长度２．５￣１９ｍｍ，平均１０．３ｍｍ。     

硝酸甘油在体外循环心内直视手术中的应用体会

我院在１１２例体外循环心内直视手术中常规应用硝酸甘油,取得了满意效果。现报告如下。 临床资料：本组男６２例,女５０例;年龄１．５～６２岁;体重８～７６ｋｇ,心胸比例０．４８～０．８１。先天性心脏病８２例,包括室间隔缺损（ＶＳＤ） ３８例,房间隔缺损（ＡＳＤ） ２９例,法乐氏四联症（Ｆ４） １２例,其它３例;心功能Ⅰ级１２例,Ⅱ级３１例,Ⅲ级３５例,Ⅳ级４例。后天性心脏病３０例,包括二尖瓣狭窄１２例,主动脉瓣病变７例,联合瓣膜病变１１例;心功能Ⅱ级８例,Ⅲ级１８例,Ⅳ级４例。麻醉方法全部采用芬太尼（１…     

环孢霉素A治疗重型再生障碍性贫血

环孢霉素Ａ（ＣｓＡ）是一有效的免疫抑制剂,近年来用于治疗再生障碍性贫血（下简称重型再障）,取得较好疗效,现将１９９５年１月～１９９７年１月以ＣｓＡ治疗及对照共１５例重型再障报告如下：１　临床资料１．１　一般资料　１５例随机分为２组,ＣｓＡ组７例,重型再障Ⅰ型（ＳＡＡ－Ⅰ）３例,重型再障Ⅱ型（ＳＡＡ－Ⅱ）４例,男５例,女２例,年龄１７～５３岁,平均３５岁。对照组８例,ＳＡＡ－Ⅰ型４例,ＳＡＡ－Ⅱ型４例,男５例,女３例,年龄１３～４７岁,平均３０岁。１．２　治疗方法　基本方案是ＳＳＬ方案,即康力龙６…     

PVCDL早期连续强烈化疗方案治疗儿童急性淋巴细胞白血病42例

近年来我院采用ＰＶＣＤＬ早期连续强烈诱导方案治疗４２例儿童急性淋巴细胞性白血病（ＡＬＬ），现将结果报告如下。１　病例和方法１．１　病例　１９９０年３月～１９９７年６月收治的初治儿童ＡＬＬ４２例，男３０例，女１２例，中位年龄６．５岁（４．５月～１２岁），标危型（ＳＲ）１５例，高危型（ＨＲ）２７例，均经临床及骨髓象确诊。ＨＲ型中治疗前ＷＢＣ计数＞１００×１０９／Ｌ６例，２例起病时合并脑膜白血病。１．２　分型　４２例ＦＡＢ分型，Ｌ１型２６例，Ｌ２型９例，Ｌ３型７例。１３例行免疫分型，Ｂ组１０例（７６．…     

经胸超声心动图在Amplatzer封堵器治疗成人巨大房间隔缺损中的应用

目的　评价经胸超声心动图监测 (TTE)Amplatzer封堵器介入治疗巨大房间隔缺损(ASD)的安全性和可行性。方法　 2 1例住院患者 ,男 12例 ,女 9例 ;年龄 17～ 4 5岁 ;均经临床及超声心动图证实的继发孔型ASD ,以充盈球囊最大伸展直径加 2～ 4mm为原则选择封堵器型号 ,TTE监测下放置Amplatzer封堵器。随访有无残余分流及是否影响周围瓣膜和静脉功能 ,记录临床事件 (血栓栓塞、心功能不全、心律失常等 )。结果　 2 1例全部封堵成功 ,TTE监测放置Amplatzer封堵成功 ,手术成功率 10 0 % ;术后即刻及 1天、3天、3个月、6个月、1年复查TTE观察无明显残余分流及影响周围瓣膜功能 ,也无腔、肺静脉狭窄 ,无血栓栓塞事件发生 ,无封堵器移位和脱落 ,心功能有不同程度的好转。1例发生频发房性心律失常 ,经心律平 4 5 0mg d治疗 1个月后消失 ,无其他并发症发生。结论　Amp latzer封堵器介入治疗成人巨大ASD是一种安全、有效的治疗方法 ,TTE监测ASD介入封堵治疗整个过程 ,可以提高一次释放成功率     

Transcatheter closure of secundum atrial septal defects with the new self-centering Amplatzer Septal Occluder.

AIMS: The study was set up to find out whether a new self-centering prosthesis for transcatheter closure of secundum atrial septal defects could overcome the disadvantages of previously described devices. METHODS AND RESULTS: Fifty-two consecutive patients with a significant atrial septal defect were considered for transcatheter closure with the Amplatzer Septal Occluder. The device, made of a Nitinol and polyester fabric mesh, provides a different approach to defect occlusion by stenting the atrial septal defect up to a stretched diameter of 26 mm. Three infants whose large defects were demonstrated on a transthoracic echocardiogram were excluded from transcatheter treatment. On transoesophageal echocardiography, 49 defects ranged from 6-26 mm, in one adult the defect measured 28 mm and this patient was excluded from attempted transcatheter closure. At cardiac catheterization in five further patients, devices were not implanted, in two because the stretched diameter exceeded 26 mm and in three the device was withdrawn because it was unstable or compromised the mitral valve. Thus, device closure was performed in 43 patients. At follow-up after 3 months the complete closure rate was 97%. CONCLUSION: The self-centering Amplatzer Septal Occluder is very efficient and user-friendly and offers interventional closure in 83% of an unselected group of patients presented with an atrial septal defect.     

Percutaneous closure of large atrial septal defects

BACKGROUND: Percutaneous occlusion of secundum type atrial septal defect with an Amplatzer device is an effective treatment alternative. However, there is little information about the use of this treatment for large defects. PATIENTS AND METHOD: We retrospectively analyzed the initial and follow-up findings in 31 patients aged 41 18 years who had large atrial septal defects (>= 30 mm diameter). Mean defect diameter evaluated by the balloon occlusion method was 33.4 3.4 mm (range, 30-40 mm). In all patients we attempted the implantation of an Amplatzer septal occluder. RESULTS: The implant was successful in 23 patients (74%); 3 of whom had a double orifice. The size of the device was 34 3 mm diameter (range, 30-38 mm). Combined associated procedures were balloon pulmonary valvuloplasty in 3 patients and coronary stent implantation in 1. In 4 out of 8 patients where we failed, the implant was attempted but the device was unstable so we decided to retrieve it; in the remaining 4 patients, balloon measurement alone contraindicated the procedure. All patients did well, but one had cardiac tamponade during the procedure that was resolved in the catheterization laboratory. After 15 12 months of follow-up all 31 patients were alive and those who had functional limitation before treatment remained stable, with significant clinical improvement. CONCLUSIONS: Percutaneous device occlusion of large atrial septal defects is feasible and effective in most patients.     

Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer Septal Occluder.

To judge whether an Amplatzer Septal Occluder can be used as standard therapy instead of surgery for closure of atrial septal defects we report our experiences in 200 patients. Of these patients, 127 had an atrial septal defect with haemodynamically significant left-to-right shunt, 68 patients a persistent oval foramen after presumed paradoxical embolism, and 5 had a fenestration after Fontan-repair. Mean age was 29.8 years (0.8 to 77.7 years). Body weight ranged from 6.9 to 120.0 kg (mean 51.5 kg). After diagnostic cardiac catheterization, and balloon-sizing of the defect, we implanted Amplatzer Septal Occluders with stents of 4 to 28 mm diameter. Follow-up studies were obtained after 48 hours, and one, six, and twelve months. Transcatheter closure of the atrial septal defect proved successful in all without any relevant residual shunts. In particular, complete closure was achieved in all patients after presumed paradoxical embolism. The mean period of follow-up is 9.5 months, with a range from 0.4 to 23.5 months, giving a total of 1898 patient months. The occlusion rate after three month was 98.1%. A trivial haemodynamically insignificant residual shunt remained in 1.9% of the patients. Fluoroscopy times ranged from 0 to 43.5 minutes, with a median of 8.7 minutes. The excellent results in the short and medium term in children and adults have resulted in using this device routinely at the present time for closure of central atrial septal defects up to a diameter of 28 mm. Final judgement, however, is only possible after long-term follow-up.     

经胸彩色多普勒超声心动图在房间隔缺损经导管封堵术中的应用价值

目的探讨经胸彩色多普勒超声心动图(TTE)在房间隔缺损(ASD)经心导管封堵治疗中的应用价值。方法应用TTE选择适于行Amplatzer式封堵术的继发孔型ASD患者27例，在TTE监测引导下经右心导管应用房间隔封堵器关闭ASD。结果26例ASD获成功封堵，术后即刻、1天、1个月和3个月TTE检查显示封堵器位置稳定良好，无残余分流。结论在TTE引导下行ASD封堵术是一种简便、可靠和安全的方法。     

Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience

OBJECTIVE—To review the safety and efficacy of the Amplatzer septal occluder for transcatheter closure of interatrial communications (atrial septal defects (ASD), fenestrated Fontan (FF), patent foramen ovale (PFO)).
DESIGN—Prospective study following a common protocol for patient selection and technique of deployment in all participating centres.
SETTING—Multicentre study representing total United Kingdom experience.
PATIENTS—First 100 consecutive patients in whom an Amplatzer septal occluder was used to close a clinically significant ASD or interatrial communication.
INTERVENTIONS—All procedures performed under general anaesthesia with transoesophageal echocardiographic guidance. Interatrial communications were assessed by transoesophageal echocardiography with reference to size, position in the interatrial septum, proximity to surrounding structures, and adequacy of septal rim. Stretched diameter of the interatrial communications was determined by balloon sizing. Device selection was based on and matched to the stretched diameter of the communication.
MAIN OUTCOME MEASURES—Success defined as deployment of device in a stable position to occlude the interatrial communication without inducing functional abnormality or anatomical obstruction. Occlusion status determined by transoesophageal echocardiography during procedure and by transthoracic echocardiography on follow up. Clinical status and occlusion rates assessed at 24 hours, one month, and three months.
RESULTS—101 procedures were performed in 100 patients (86 ASD, 7 FF, 7 PFO), age 1.7 to 64.3 years (mean (SD), 13.3 (13.9)), weight 9.2 to 100.0 kg (mean 32.5 (23.5)). Procedure time ranged from 30 to 180 minutes (mean 92.4 (29.0)) and fluoroscopy time from 6.0 to 49.0 minutes (mean 16.1 (8.0)). There were seven failures, all occurring in patients with ASD, and one embolisation requiring surgical removal. Immediate total occlusion rate was 20.4%, rising to 84.9% after 24 hours. Total occlusion rates at the one and three month follow up were 92.5% and 98.9%, respectively. Complications were: transient ST elevation (1), transient atrioventricular block (1), presumed deep vein thrombosis (1), presumed transient ischaemic attack (1).
CONCLUSIONS—It appears feasible to close interatrial communications and atrial septal defects up to 26 mm stretched diameter safely with the Amplatzer septal occluder. Short term results confirm an early high occlusion rate with no major complications. Careful selection of cases based on the echocardiographic morphology of the ASD and accurate assessment of their stretched diameter is of utmost importance. Further experience with the larger devices and longer term results are required before a firm conclusion regarding its use can be made.


Keywords: interatrial communications; atrial septal defect; Amplatzer septal occluder; congenital heart defects     

New echocardiographic diameter for Amplatzer sizing in adult patients with secundum atrial septal defect: preliminary results.

Anatomical atrial septal defect (ASD) diameter measured by transesophageal echocardiography (TEE) underestimates the Amplatzer septal occluder (ASO) size for ASD closure. The aim of this study is to investigate whether a new echocardiographic diameter (procedural ASD diameter) may enable precise measurements of ASO device size. Fifty adult patients with secundum ASD were evaluated by TEE for percutaneous closure. The procedural ASD diameter was measured using the steadier rim borders where thickness was 2.5 mm. Out of the 50 patients, 12 were considered unsuitable for Amplatzer device closure. The other 38 patients underwent percutaneous closure. The mean anatomical ASD diameter was 14.8 +/- 7.0 mm, the mean procedural ASD diameter measured 19.5 +/- 8.1 mm, and the mean stretched balloon diameter (SBD) was 20.0 +/- 8.0 mm. ASO device size was 20.1 +/- 8.0 mm. At linear regression analysis, a high correlation (r = 0.99) was found between procedural ASD diameter and SBD. Procedural ASD diameter correlates with SBD and may allow reliable prediction of Amplatzer device in an adult population undergoing percutaneous ASD closure.     

Interventional occlusion of atrial septum defects larter than 20 mm in diameter

Over the last few years, various devices for the interventional closure of atrial septal defects (ASD) up to a diameter of 20 mm have been developed. We report our clinical experience in closing ASD with a diameter larger than 20 mm diameter with the Amplatzer Septal Occluder (ASO). METHOD: The stretched diameter of the ASD was measured by inflating a sizing balloon within the defect until an indentation in the circumference in the balloon could be observed. An ASO with a stent diameter 2-4 mm larger than the indentation in the circumference of the balloon was chosen and implanted via 9-12 French sheaths. In contrast to the closure of smaller defects, pullback of the device onto the atrial septum was only performed when the connecting stent of the ASO was completely deployed in order to achieve maximal centering characteristics and optimal support of the retention skirt of the left atrial disc on the edges of the defect. Only then was the right atrial disc deployed and actively configured by advancing the sheath and the delivery cable against the atrial septum. Implantation was only attempted if the atrial septal rims (except the anterior rim around the aorta) measured more than 7 mm by echocardiography to avoid injury or disturbance of sensitive intracardiac structures. After placement, the fixation of the device and the mechanical stability was proven by an extensive "Minnesota wiggle". The ASO was released only when TEE showed no or a trivial residual color flow through the connecting stent; otherwise repositioning was performed. RESULTS: Out of 352 patients (P) with successful closure of interatrial defects, 70 P (age: 1.1-77.3 years) had stretched defects larger than 20 mm diameter (median 22 mm diameter (20-36), 25/75% quartiles = 20/26 mm). Mean shunt size was Qp:Qs 2.1:1 (0.7-3.9:1), mean fluoroscopy time 10.9 min (0-63). Complete closure could be achieved in 85.7/93.1/100% after 3 months, 1 and 2 years, respectively. Besides 3 P with persistent atrial fibrillation, only 5 P showed transient atrial tachyarrhythmias, 2 only periprocedural and 3 within the first 3 months after implantation were treated with beta-blocker. In one patient, an acute embolization of the device occurred because a diminished posterior rim was not visualized by a monoplane TEE probe necessitating surgical explantation and defect occlusion. Despite oversizing the device, no "mushrooming" misconfiguration were observed. CONCLUSION: Transcatheter closure of large atrial septal defects with the Amplatzer Septal Occluder is feasible, safe and effective. Risk of complications do not seem to occur more frequently than after closure of smaller defects if one adheres to certain sizing and implantation measures. The incidence of transient atrial tachyarrhythmias seems to be low.     

The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder

BACKGROUND: Our purpose was to determine the role of transesophageal echocardiography (TEE) in the closure of atrial septal defects by the Amplatzer septal occluder (ASO) (AGA Medical, Golden Valley, Minn). METHODS: A total of 240 patients with atrial septal defect (ASD) secundum were examined by transthoracic 2-dimensional echocardiography (TTE) and TEE to determine the ASD morphologic features, diameter, and rims. During transcatheter closure TEE was used for determination of the ASD diameter and guidance of the ASO implantation. RESULTS: Sixteen (6%) patients were found not suitable for transcatheter closure with TTE, 35 (14%) with TEE, and 2 during catheterization. Twenty-eight patients (18%) had partial or total deficiency of the posterior, inferoanterior, or inferoposterior rim, 54 (27%) had a centrally positioned ASD, 92 (46%) had insufficient superoanterior rim, and 9 had multiple ASDs, whereas 8 had a septal aneurysm associated with a single defect and 4 a multiperforated aneurysm. A total of 170 patients underwent implantation of ASO. The ASO was correctly positioned in 144 at the first attempt. In the remainder TEE revealed unstable position of the left atrial disk (12), opening of both atrial disks in the left atrium (5), deployment of the device through the smaller defect in patients with multiple ASDs (3), and, in 1 patient, the device was too small and had to be replaced by a larger one. CONCLUSIONS: Morphologic variations of the ASD are common. TEE is crucial for the determination of the ASD morphologic features, diameter, and rims, which are crucial for proper patient selection. TEE allows precise guiding and positioning of the ASO, which is essential for safe and effective transcatheter ASD closure.     

Early and late complications associated with transcatheter occlusion of secundum atrial septal defect

OBJECTIVES: The goal of this study was to report the early and late complications experienced in atrial septal defect (ASD) transcatheter closure. BACKGROUND: Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and rate of complications are different for different devices. METHODS: Between December 1996 and January 2001, 417 patients (mean age: 26.6 +/- 19 years) underwent transcatheter occlusion of secundum type ASD. Complications were categorized into major and minor. Two different devices were used: the CardioSEAL/STARFlex in 159 patients and the Amplatzer septal occluder in 258 patients. RESULTS: Thirty-four patients experienced 36 complications during the hospitalization (8.6%, 95% confidence interval: 6.1% to 11.1%). Ten patients underwent elective surgical repair because of device malposition (three patients) or device embolization (seven patients). Twenty-four patients experienced 25 minor complications: unsatisfactory device position or embolization. Devices were retrieved using a gooseneck snare and/or a basket; 11 patients experienced arrhythmic problems. Other complications were: pericardial effusion, thrombus formation on the left atrial disc, right iliac vein dissection, groin hematoma, hemorrhage in the retropharynx and sizing balloon rupture. Two patients had late complications: peripheral embolization in the left leg one year after implantation of an Amplatzer device and sudden death 1.5 year later. CONCLUSIONS: Our series of patients with ASD by transcatheter occlusion shows that the procedure is safe and effective in the vast majority of cases. To further reduce the complications rate, the criteria of device selection according to ASD morphology and some technical tips during implantation are discussed.