心腔内超声心动图监测下经导管堵闭腔静脉型房间隔缺损临床研究

目的 探讨腔静脉型房间隔缺损(ASD)在心腔内超声心动图(ICE)监测下经导管堵闭的安全性和有效性.方法 2006年10月至2007年4月,广东省人民医院心儿科应用ICE监测经导管堵闭继发孔型ASD18例,其中腔静脉型ASD12例(67%).男2例,女10例.年龄2～11岁,平均(6.4±2.8)岁.体重11.0～35.0kg,平均(21.0±7.1)kg.ASD大小:11.6～32.0mm,平均(24.3±6.2)mm,下腔静脉型8例(67%),上腔静脉型4例(33%),Qp/Qs:1.8～4.7,平均(3.4±0.8),肺动脉压力:22～37mmHg,平均(32.3±5.1)mmHg.6例为多发型ASD.对于非圆形大ASD,采用球囊测量ASD伸展径.选择比ASD大0～2mm堵闭器,ICE监测下打开堵闭器左房盘、连接腰部及右房盘,如为下腔静脉型大ASD,采用特殊由度的鞘管,使左房盘打开后平行于房间隔,于靠近缺损处打开连接腰部堵塞缺损,再迅速打开右房盘.结果 全组11例(92%)堵闭成功,堵闭器大小:13～34mm,平均(26.0±6.4)mm;3例少量残余分流,1例堵闭失败,均为多发ASD.无并发症发生.手术时间:60～150mim,平均(88.2±24.1)min,X线曝光时间:12～32min,平均(16.0±6.1)min.随访6～12个月,无堵闭器移位、心内膜炎及脑栓塞等发生.结论 腔静脉型ASD在ICE监测下经导管堵闭具有可行性.     

经导管非开胸法关闭房间隔缺损15例报告

为探讨先天性心脏病房间隔缺损（ＡＳＤ）的非开胸疗法，采用经导管纽扣式补片对１５例ＡＳＤ患儿进行关闭治疗及随诊研究。患儿年龄２．５～１４．０岁，平均７．５岁；体重１１～３９ｋｇ，平均２０ｋｇ。采用彩色多普勒超声心动图（ＣＤＦＩ）、右上肺静脉造影及球囊三者结合测量来确定ＡＳＤ最大伸展直径。选择大于所测直径的２．０～２．５倍补片和相应长鞘。结果，１３例关闭成功（８７％），２例由于房间隔呈半弧圆形或不规则型，撤除补片改行外科手术治疗。１３例成功者，术后第２天残余分流５例（３８％），随诊１～１２个月残余分流下降为２例（１６％），１例有轻度二尖瓣关闭不全。提示，经导管纽扣式补片关闭ＡＳＤ的方法既简便、安全，又疗效佳，但有一定局限性，尚待进一步改进和完善。     

经导管Amplatzer房间隔封堵器关闭儿童继发孔型房间隔缺损:应用限度及技术探讨

为探讨Amplatzer房间隔封堵器 (ASO)在儿童中的应用限度 ,并进行方法学评价 ,共有68例符合手术指征的继发孔型ASD患儿接受了经导管ASO封堵术。术中经右上肺静脉造影、经食道超声心动图 (TEE)测量ASD位置、大小及周围关系 ,并以扩张球囊测量ASD伸展直径 ,按此选择等于或大于其1mm～2mm的封堵器 ;对于>25mm伸展直径的ASD或房缺主动脉根部前缘缺如的ASD ,所选ASO应大于其2mm～4mm。房缺前缘近主动脉根部的缺如并不影响装置的成功放置 ,但房缺后上缘是否有足够距离对手术的成功是决定性的。手术操作按常规进行。术后即刻行TEE或TTE检查观察治疗效果 ,此后定期检查评价疗效。结果68例患儿ASD术前TEE直径 (13.26±4.74)mm ,球囊伸展直径 (15.96±5.44)mm ,选用封堵器腰部直径 (10～32)mm,平均 (16.35±5.81)mm。68例均一次手术封堵成功 ,技术成功率100 % ;65例术后即刻TEE/TTE检查示完全封堵无分流 ,完全封堵率95.6% ;3例术后发生无血液动力学意义的少量残余分流 ,残余分流率4.4 % ,2例24小时后TTE复查分流消失 ,1例1年后消失。除2例装置释放后曾出现一过性房性早搏 (2.9 %)外 ,无其它并发症发生。结果表明虽然ASO对堵塞继发孔型房缺安全有效、无并发症、无死亡率、装置结构简单、操作方便、可多次回撤与重新     

经食管超声心动图引导经颈静脉封堵婴儿房间隔缺损（附13例报告）

目的　探讨经食管超声心动图引导下经颈静脉封堵婴儿房间隔缺损的应用价值。方法　回顾性分析2015年6月至2018年3月在青岛市妇女儿童医院经食管超声心动图引导经右侧颈静脉行房间隔缺损封堵的13例1岁以内房间隔缺损患儿，评价手术效果、手术时间及并发症等临床资料。结果　13例婴儿均封堵成功，食管超声心动图可准确引导输送轨道的建立，手术时间（27.2±15.1）min。全部患儿封堵器形态满意、位置固定，无新发心律失常、溶血、栓塞、感染、气胸、血胸及心血管损伤等并发症。结论　经食管超声心动图引导下经右侧颈静脉封堵婴儿房间隔缺损方法可行，可避免外科手术风险及低年龄、低体重患儿介入血管并发症，同时可避免潜在的辐射损伤。     

超声心动图引导球囊房间隔造口术治疗新生儿重症先天性心脏病

目的、方法采用UM4型超声心动图仪床边监测引导球囊房间隔造口术(BAS)姑息治疗新生儿重症先天性心脏病10例,其中完全性大动脉转位5例,完全性肺静脉畸形引流3例,解剖纠正型大动脉转位和左心发育不良并肺静脉引流异常各1例.结果10例中8例造口成功,效果满意.超声测量房间隔缺损口径4.5～10mm,平均7.5mm;多普勒测穿隔血流速度由1.87±0.2m/sel降至0.71±0.2m/eel;压力阶差由12.70±3.0降至2.06±1.46mmHg(P＜0.01).5例完全性大动脉转位血氧饱和度由53.6±15.96%升至78.0±12.55%(P＜0.01).2例不成功因合并卵圆孔早闭及心室反位罕见畸形引起.结论BAS在超声引导下更加简便易行,安全可靠,对改善依赖卵圆孔开放维持生命的先心病患儿临床症状、延长生命有重要帮助.     

经心导管关闭房间隔缺损的临床评价

本文对双伞闭合器和扣式闭合器关闭房间隔缺损（ＡＳＤ）的临床疗效、适应症和并发症进行了评价，其总的有效率在９０％～９５％之间，术后小的残余分流并不造成血流动力学的变化，并可自发消失。其适应症不仅包括缺损口伸展直径＜２５ｍｍ的中央型ＡＳＤ，也适合并发其它心血管疾病的的病人，尤其是卵圆孔未闭的病人可免于外科手术。术前右肺上静脉造影及伸展直径的测量可避免一系列并发症的发生。     

单纯食管超声引导经皮封堵治疗房间隔缺损

目的 通过与传统放射线引导方法相比较,评价单纯经食道超声(TEE)引导在经皮介入封堵儿童房间隔缺损中的早期临床应用效果.方法 收集2012年10月至2014年1月单纯TEE引导下经皮房间隔缺损封堵患儿50例(TEE组),均采用TEE引导并监测封堵全过程.选取同期传统放射线引导下经皮房间隔缺损封堵患儿162例为对照组.2组患者均于术后1个月在门诊随访,并行经胸超声心动图检查.结果 2组患儿年龄、体质量、房间隔缺损直径、封堵器直径、手术时间及住院时间无明显差异.TEE组和对照组封堵器置入成功率分别为100.0％和97.5％,2组比较差异无统计学意义(P=0.58);术后即刻残余分流发生率分别为0和4.4％,2组比较差异无统计学意义(P=0.20);气管插管时间分别为(2.9±0.5)h和0.术后随访1个月,2组患者均无残余分流,未发生外周血管损伤、心脏穿孔、封堵器脱落等严重并发症.结论 单纯TEE引导下经皮介入封堵儿童房间隔缺损不仅能够完全避免放射线及对比剂,而且保持了传统经皮介入治疗安全、微创的优点.     

经导管Amplatzer封堵器堵闭小儿房间隔缺损46例报告

目的探讨应用Ampplatzer封堵器堵闭小儿房间隔缺损(AsD)的可行性。方法46例AsD患儿,年龄2～15岁,平均(7.5±4.2)岁,在基础麻醉下,先行右心导管用测量球囊导管测量AsD大小,选择适合的封堵器,在超声指导下放出封堵器堵闭AsD,然后监测封堵器位置是否满意、有否残余分流、房室瓣有否累及,以达到完全堵闭效果。结果46例全部成功,无一例有合并症;手术时间(65.88±20.78)min,透视时间(11.05±4.04)min。结论经导管AmplatzerAsD堵闭术是一种安全、有效的方法,适用于2岁以上、缺损口在30mm以下的继发孔AsD患儿。但必须严格掌握适应证,术中必须应用经胸超声心动图或食道超声帮助提高堵闭术的成功率,减少并发症。     

超声心动图在应用Amplatzer封堵器关闭儿童房间隔缺损中的应用价值

目的　评价经胸超声心动图 (TTE)和经食管超声心动图 (TEE)在应用Amplatzer封堵器关闭儿童房间隔缺损(ASD)中的应用价值。方法　对 12例拟诊为继发孔型ASD的儿童 (年龄 2～ 13岁 ) ,应用Amplatzer封堵器经导管关闭ASD。通过TTE和 (或 )TEE在术前显示ASD大小及其边缘的解剖特点 ,术中指导封堵器的放置 ,术后评价疗效。结果　 (1) 12例中 ,TEE排除ASD诊断 1例 ,诊断为下腔型ASD和显示缺损前上缘薄弱者各 1例 ,这 3例未实施封堵术。 (2 )TEE测量ASD大小 (5～ 2 6mm ,平均 13 6mm) ,与ASD伸展径 (7～ 30mm ,平均 16 6mm)具有高度相关性 (r=0 994 ,P <0 0 1) ;与术前TTE测量ASD大小很接近 (5～ 2 1mm ,平均 14 3mm) ,后者与ASD伸展径亦具有高度相关性 (r =0 932 ,P <0 0 1)。 (3) 9例实施封堵术者 ,有 8例封堵成功 ;1例在封堵器释放后 15min发生脱落 ,改为外科修补。 (4) 8例成功实施封堵术者经TTE随访 1～ 2 2个月 ,无残余分流征象。结论　应用Amplatzer封堵器经导管关闭ASD可取得良好效果 ;超声心动图在经导管关闭ASD过程中具有重要价值 ,TTE和TEE各具优点 ,TTE适用于病例的初步筛选和术后随访 ;而TEE则在决定是否进行封堵术和指导封堵器的正确放置等方面发挥重要的作用。     

Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance

Background

This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.

Methods

We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients’ mean age was 60.09?±?36.42 months (13–182 months), and their mean body weight was 20.16?±?10.04 kg (9–77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms.

Results

The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58?±?5.31 mm (3–28 mm), and the mean size of the occlusion device was 16.07?±?5.29 mm (6–36 mm). The mean procedural times were 13.33?±?2.82 minutes (6–16 minutes). The mean hospitalization costs were 27,259.66?±?2507.04 RMB (25,200.00–33,911.45 RMB). The mean postoperative hospital stay was 3.22?±?0.53 days (3–5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation.

Conclusion

Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.

     

小儿房间隔缺损介入治疗40例临床报告

目的 评价小儿继发孔型房间隔缺损(ASD)应用美国AGA公司的Amplatzer封堵器介入治疗的临床疗效。方法 Ⅱ孔型ASD40例。男16例,女24例;年龄3～15岁,平均10．2岁。体重11～87kg,平均35．8kg.6例合并肺动脉瓣狭窄(PS),1例合并二尖瓣脱垂和轻度关闭不全,l例台并室性心动过速(VT)。40例均采用美国AGA公司的AmplatzerASD封堵器。术中常规行右心导管检查,测量右室、肺动脉压力。经导引钢丝导人球囊导管测ASD最大伸展直径。用体表经胸超声心动图(TTE)或食道超声(TEE)测量房间隔直径及确定ASD的位置及大小。根据球囊最大伸展直径选择等于或大于l～2mm型号的ASD封堵器。结果 40例患儿应用40个Amplatzer封堵器封堵成功,成功率100%。经TTE测量ASD直径为7～30mm(平均17．12mm),TEE测量直径为7～32mm(平均18．44mm)。最大球囊伸展直径为8～34mm(平均20．56mm)。Amplatzer封堵器型号8～38mm(平均21．44mm)。合并PS,先行球囊扩张术,成功后再封堵ASD。合并VT先行射频消融术而后成功封堵ASD.40例无并发症,无残余分流。术后3—4天出院。术后3d复查ECG、TTE及X线胸部检查有明显改善。结论 AmplatzerASD封堵器封堵小儿ASD是安全、有效的。规范化治疗。严格掌握适应证是成功的保证。     

Transcatheter device closure of congenital ventricular septal defects

Ventricular septal defects (VSD) are among the most commonly occurring congenital heart lesions. While successful surgical repair of VSDs has been possible for over 60 years, peri-operative and late complications still occur and there are inherent risks associated with sternotomy and exposure to cardiopulmonary bypass. A desire to avoid these risks, as well as the successful application of catheter-based device closure for other intracardiac and vascular shunting lesions, has lead to an interest in developing a less invasive means by which to close VSDs. The aim of this article is (a) to understand the important differences in approach to catheter-based closure of congenitally occurring VSDs, based on their location, (b) to discuss the technical aspects of device closure of VSDs, from both a percutaneous and perventricular (hybrid) approach, and (c) to review the outcomes of the experience with these devices. Acquired (post-infarction, post-trauma) VSDs will not be addressed.     

儿童继发孔型房间隔缺损的介入治疗

目的　探讨儿童继发孔型房间隔缺损 (atrialseptaldefect ,ASD)封堵术的指征、方法学和并发症的预防。方法　 1998年 10月～ 2 0 0 3年 1月 ,119例继发孔型ASD患儿 ,根据家属意愿接受了经导管应用Amplatzer房间隔封堵器的介入治疗。年龄 0 8～ 17 0岁 ,平均 ( 7 5± 2 8)岁 ,体重6 7～ 88.0kg ,平均 ( 2 3 7± 7 8)kg。所有病例术前检查被证实均为继发孔型ASD。按ASD球囊伸展直径或大于 1～ 2mm选择封堵器进行堵塞。其中 3例为多发ASD。 6例合并动脉导管未闭 ( patentductusarteriosus,PDA)或肺动脉瓣狭窄 ( pulmonarystenosis ,PS)者应用其他封堵装置和球囊扩张治疗合并的畸形。术后定期行心脏超声及临床检查随访。结果　 119例患儿术前经食道超声(transesophagealechocardiography ,TEE)或经胸超声 (trans thoracicechocardiography ,TTE)检测ASD平均直径 ( 12 9± 5 6 )mm ( 6 5～ 34 5mm ) ,肺动脉平均压力为 ( 2 9 0± 5 0 )mmHg( 2 5 0～ 6 2 0mmHg) ,球囊伸展直径为 ( 15 7± 4 8)mm( 8 0～ 38 0mm)。所选封堵器直径平均为 ( 15 0± 5 0 )mm( 8 0～ 38 0mm)。 112例封堵成功。 3例多发ASD也选用单一封堵器。 6例合并PDA或PS者同时完成介入治疗。 112例堵塞后即刻封堵率为 93 8% ( 1     

Transcatheter closure of secundum atrial septal defects, a ventricular septal defect, and a patent arterial duct

We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.