继发孔型房间隔缺损微创封堵的临床研究

目的总结微创封堵治疗继发孔型房间隔缺损的初步经验。方法全组11例,手术前均确诊为继发孔型房间隔缺损,缺损长径14.6～32.5mm。取右前胸2～3cm长的微创切口,在食管超声心动图引导下,经输送器置入封堵伞,以闭合房间隔缺损。结果11例患者手术均获得成功,无手术相关并发症发生。随访3～10个月,封堵伞无移位、无残余漏。结论微创封堵手术治疗继发孔型房间隔缺损具有安全、高效的优点。     

微创非体外循环房间隔缺损封堵术的临床应用

目的总结我院微创非体外循环房间隔缺损封堵术的临床应用经验。方法对10例继发孔型房间隔缺损(ASD)患者进行微创非体外循环房间隔缺损封堵术。全麻下右侧胸骨旁第4肋间4-6cm切口,食管超声(TEE)测量房间隔缺损最长径,选择适当封堵伞,TEE监测下释放封堵伞,了解有无残余分流等异常。结果10例患者手术均成功,术中未发生任何并发症,术后复查心彩超未见残余分流。2例出现术后高血压,给与降压对症治疗,1例中度肺动脉高压复查心彩超肺动脉压明显下降,术后右心大小较术前有减小。结论微创非体外循环房间隔缺损封堵术是一种微创手术治疗方法,值得推广、发展。     

儿童经胸小切口房间隔缺损封堵术的临床体会

目的 探讨经胸小切口房间隔缺损封堵术治疗房间隔缺损（ASD）的疗效.方法 胸骨右旁第4肋间切口长2cm,切开心包并悬吊,于右心房壁缝双荷包线,并切开,将输送导管（国产）插入右心房内,通过房间隔缺损口入左心房,在经食管超声监视下,释放出房间隔封堵伞,调整左右侧伞盘夹紧封堵ASD,用保险绳做反复牵拉试验,确认封堵伞位置合适.结果 8例均成功封堵,手术时间25～35 min,平均30 min;术后住院3～6d.术后2～10个月复查,心脏彩超检查封堵伞无移位,无残余分流.结论 在经胸壁超声监视下房间隔缺损封堵术是一种微创、安全、简便,值得推广的方法.     

经胸小切口非体外循环房间隔缺损封堵术的临床应用

目的总结经胸小切口非体外循环下房间隔缺损封堵术的临床应用经验。方法2005年12月我们对2例巨大继发孔型房间隔缺损患者采用经胸小切口非体外循环下进行外科封堵术。全麻下经右胸第4肋间胸骨旁3～4cm小切口入胸,经食管超声引导下将合适型号的外科专用房缺封堵器释放,关闭房间隔缺损,并实时监测封堵器的位置、有无残余分流以及是否累及房室瓣及冠状静脉窦。结果2例患者均1次封堵成功,术后无残余分流,无封堵器脱落,痊愈出院。结论经胸小切口非体外循环房间隔缺损封堵术创伤小、操作简单、安全性高,具有推广应用价值。     

房间隔缺损的微创外科治疗

目的观察微创手术治疗房间隔缺损的疗效。方法选择房间隔缺损患者21例,取胸骨右旁第4肋间做3cm切口,切开心包并悬吊,于右心房壁缝双荷包线,并切开,将输送导管(国产)插入右心房内,通过房间隔缺损口入左心房,在经左胸壁超声监视下,释放出房间隔封堵伞,用保险绳做反复牵拉试验,确认封堵伞位置合适,再做一针贯穿右房壁和伞边缘的褥式缝合固定。结果全部患者手术过程顺利,平均手术时间60min,其中平均心内操作15min。患者住院5～7d,术后2～6个月复查,心脏彩超检查封堵伞无移位,无残余分流。结论在经胸壁超声监视下房间隔缺损封堵术是一种微创、安全、简便的治疗方法。     

右腋下小切口心脏不停跳修补房间隔缺损的临床经验

目的 总结经右腋下直切口行体外循环直视、心脏不停跳下房间隔缺损修补手术的临床经验,探讨其适应证及技术要点。 方法 2011年1月至2016年12月我们共完成92例经右腋下直切口的体外循环心脏直视手术,其中男52例、女40例,患者年龄12个月至28岁,平均(5.2±3.3)岁,体重8.5～52.0(17.9±8.6)kg。其中2例合并部分型肺静脉异位引流,6例存在中度以上肺高压,同期行三尖瓣成形39例。所有手术均在全身麻醉、体外循环心脏不停跳下进行。患者取左侧卧位,切口位于腋中线与腋前线之间,皮肤切口长度约5～8cm,约经第3或第4肋间进胸,切开并悬吊心包,行升主动脉及上、下腔静脉插管建立体外循环,经右心房切口修补房间隔缺损及三尖瓣成形。结果 全组手术均顺利完成,无手术死亡;术中无恶性心律失常和气栓发生,术后无脑部并发症,2例术后出现少量气胸、皮下气肿,1例出现肺不张,1例随访有1～2mm残余分流。结论 右腋下小切口心脏不停跳下心内修补房间隔缺损手术具有安全、可靠,美容效果好、创伤轻、手术时间短以及术后恢复快等优点,患者及家属满意率高,值得临床推广。     

微创非体外循环房间隔缺损封堵术的临床应用

目的小结微创非体外循环下房间隔缺损(ASD)封堵术的临床应用经验. 方法对12例继发孔型ASD患儿,年龄2～16岁,平均(5.9±3.8)岁,进行微创非体外循环房间隔缺损封堵术.全麻下经右胸第4肋间胸骨旁2～3 cm小切口入胸,根据超声心动图选择合适的封堵器类型,超声引导下释放封堵器关闭ASD,实时监测封堵器的位置、有无残余分流以及是否累及房室瓣及冠状静脉窦. 结果12例患儿均1次封堵成功,超声引导下释放封堵器的时间为3～14 min,平均(6.5±3.1)min,无封堵器脱落,无残余分流.术后3～5天出院.结论经右胸小切口置入房间隔缺损封堵器是一种安全、有效的治疗方法,值得推广使用.     

心脏超声辅助非体外循环下房间隔缺损堵闭术18例

目的 用微创手术方法治疗房间隔缺损及其疗效观察。方法 治疗房间隔缺损患者18例,手术取右胸前外侧切口,于胸骨旁第4肋间切开3 cm长切口,经肋间进胸,切开心包并悬吊,用APACSM房间隔封堵伞,于右心房壁与房间隔缺损对应处缝双荷包线,在右心房荷包线内切开右心房壁,将输送器插入心房内,通过房间隔缺损口直到左心房腔,在食管超声监视下,用推送杆释放出房间隔封堵伞。结果 全部患者手术过程顺利,平均手术时间40分钟,其中平均心内操作10分钟。患者住院5～7日,术后6个月复查,心脏彩超检查堵片无移位,无残余分流。结论 食管超声辅助下房间隔缺损堵闭术是一种微创、安全、确切的治疗方法,病人恢复快,此手术方法有广阔的发展前景。     

经导管介入治疗继发孔型房间隔缺损的并发症及其处理

目的探讨经导管介入治疗继发孔型房间隔缺损(ASD)的并发症及其处理办法。方法回顾性分析经导管介入封堵治疗的86例继发孔型ASD患者(男性34例,女性52例)术中及术后发生的并发症,并对并发症的处理进行总结。结果手术成功率95.3%(82/86),4例未成功者中1例封堵器脱落,急诊转心外科开胸手术取出封堵器并同时行房间隔缺损修补术;1例为置入封堵器后发生Ⅲ度房室传导阻滞,故回收封堵器,并给予激素、异丙基肾上腺素及临时心脏起搏治疗,术后24h房室传导阻滞消失;1例ASD下腔静脉边缘3mm,封堵器无法固定;1例为40mm巨大ASD,选择48mm的封堵器仍有残余分流而回收封堵器,行手术治疗。术后即刻行TTE检查,2例存在少量残余分流,术中冠状动脉空气栓塞1例,急性心包填塞1例,急诊外科手术修补后治愈。1例术后2d发生脑栓塞,1例于术后1周发现右下肢水肿,血管超声提示右髂静脉炎,未治疗,随访1个月症状消失。本组无死亡病例。随访3个月时无1例残余分流。结论应用封堵器介入治疗继发孔型房间隔缺损严重并发症发生率低,是一种安全、疗效可靠的治疗方法。     

不同微创技术在继发孔房间隔缺损治疗中的应用

目的对比不同微创技术在继发孔房间隔缺损治疗中的应用结果,分析其优缺点,探讨最佳手术适应证。方法 2005年1月到2010年11月我院采用微创技术治疗继发孔房间隔缺损患者140例,年龄0.3～50岁,其中经皮导管封堵术60例,非体外循环下经胸封堵术30例,常温体外循环心脏不停跳腋下小切口修补术50例。观察和比较三种微创技术治疗房间隔缺损的手术成功率、切口长度、费用等。结果经皮导管封堵术、非体外循环下经胸封堵术、腋下小切口修补术的成功率分别为95、96.7及100,三组间无显著差别（P〉0.05）,无住院死亡。三组手术切口长度分别为（0.25±0.06）cm、（4.53±1.32）cm和（10.43±2.57）cm,差异有统计学意义（P〈0.01）;手术费用分别为（24146±3073）元,（24811±3255）元,（23300±4799）元,差异无统计学意义（P〉0.05）。结论三种手术方式均是继发孔型房间隔缺损安全有效和小创伤的治疗方法。     

Comparison of clinical outcomes and postoperative recovery between two open heart surgeries:minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy

Objective:To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median sternotomy through right atrium in treatment of common congenital heart diseases.Methods:Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomv from May,2011 to February,2013 and 77 cases of same diseases with traditional median sternotomy in the past three years were retrospectively analyzed,including atrial septal defect,membranous ventricular septal defect and partial endocardial cushion defect.The results were compared from the two groups,including the time for operation and cardiopulmonary bypass,amount of blood transfusion,postoperative drainage,ventilation time,hospital stay,and prognosis.Results:No severe complications happened in both groups,like deaths or secondery surgery caused by bleeding.No significant differences were in CPB time and postoperative ventilator time between groups(P0.05),while for all of the operative time,the length of incision,postoperative drainage and hospital stay,minimally invasive right axillary vertical thoracotomy was superior to median sternotomy,with statistically significant differences(P0.05).In six-month lollowup after operation,no complications of residual deformity and pericardial effusion were found in both groups bv doing echocardiography,but mild pectus carinatum was found in X patients in the traditional median sternotomy group(traditional groupi.whereas patients in another group were well recovered.Conclusions:Minimally invasive right subaxillary vertical thoracotomv for common congenital heart diseases is as safe as traditional median sternotomy,without the increasing incidence of postoperative complications.Additionally,compared with traditional median sternotomy,minimally invasive right subaxillary vertical thoracotomv is better in the aspects of hidden incision,appearance,and postoperative recovery.     

经胸超声心动图监测下用Amplatzer封堵器治疗房间隔缺损

目的：评价在经胸超声心动图(TTE)监测下用Amplatzer封堵器介入治疗房间隔缺损(ASD)的可行性及实用价值。方法：全组共18例继发孔型ASD患者，均在常规C型臂X线机透视和TTE指导下经导管置入Amplatzer封堵器。结果：18例患者中有2例未放置成功而改为开胸手术；16例均成功置入Amplatzer封堵器，即刻完全堵闭，术后随访3个月至2年，TTE示ASD仍被完全封闭，未见残余分流。随访期间无任何并发症。结论：在TTE和X线透视指导下用Amplatzer封堵器治疗继发孔型ASD安全可行，具有一定实用价值。     

超声心动图检查继发孔型房间隔缺损封堵术后并发症的诊断价值

目的:研究超声心动图检查继发孔型房间隔缺损封堵术后并发症的应用价值。方法:选取我院2009年7月至2018年7月确诊继发孔型房间隔缺损并行经导管或经胸封堵术的患者3910例,所有患者术前经胸超声心动图(TTE)或经食管超声心动图(TEE)诊断筛选适应证,术中经经胸超声心动图或经食管超声心动图监测,术后复查经胸超声心动图,观察评价封堵器形态位置,评估相关并发症。结果:3910例行房间隔封堵术的患者中,封堵器脱落8例(0.20%),均急诊转外科修补治疗。心脏穿孔/磨蚀事件共8例,其中主动脉窦-右心房瘘1例(0.03%),经皮封堵治疗成功;二尖瓣前叶穿孔2例(0.05%),予随诊观察7年未特殊处理;心脏穿孔或心房壁损伤5例(0.13%),其中1例死亡(0.03%),4例行心包穿刺引流后好转(0.10%)。术后心包积液102例(2.61%),其中8例为少中量-中量心包积液,术后随访无明显变化或有所增多,患者血流动力学稳定,予随诊观察;94例为微量-少量心包积液,随诊观察积液量未见增加。术后残余分流167例(4.27%),其中多发房间隔缺损共102例;另外残余分流束宽度大于等于5 mm共17例,残余分流束小于5 mm或少量分流共150例,复查后分流均减少或消失。结论:房间隔缺损封堵术相关严重并发症包括封堵器脱落、心脏穿孔/磨蚀,发生率极低但危害大,常见并发症包括心包积液和残余分流,发生率低且预后好,超声心动图在及时诊断并发症和随访观察方面起到了不可替代的作用。     

经静脉闭合房间隔缺损的疗效观察

目的 :评价经静脉置入 Amplatzer封堵器治疗继发孔型房间隔缺损 (ASD)的疗效。方法 :2 4例患者术前经多普勒超声心动图检查 ASD直径为 6～ 30 (18.96± 7.0 3) m m。在透视及经超声心动图引导下经静脉置入Am platzer封堵器闭合 ASD。结果 :2 4例 ASD直径的球囊测量值为 15～ 36 (2 6 .2 5± 7.5 7) mm ,选择的封堵器直径为 14～ 36 (2 6 .5 2± 7.15 ) m m。 2 4例封堵器置入均获得成功 ,术中无并发症 ,1例在术后第 3天出现 度 型房室传导阻滞 ,2周后恢复。 7例术后即刻超声检查显示微量残余分流 ,术后 1周复查均无分流。结论 :经静脉置入 Amplatzer封堵器治疗 ASD是一种有效的非外科手术方法。     

经胸微创封堵术治疗继发孔房间隔缺损109例分析

目的 探讨经胸非体外循环房间隔缺损微创封堵术治疗房间隔缺损的疗效.方法 全组109例患者,年龄3～63岁,ASD直径6～36 mm,均在全麻下经右胸第4肋间隙小切口进胸在经食管心脏彩超引导下经输送器置入封堵器闭合ASD.结果 106例手术成功封堵,手术时间（1.5±0.3）h,术中失血量平均（41.5±10.3）ml.3例患者因术中封堵失败改为体外循环下修补.全组无死亡,术后3～9d恢复后出院.随诊3～36个月.B超示封堵伞没有残余漏,没有移位,心功能改善显著.结论 经胸微创房间隔缺损封堵手术简单、创伤小、安全性高、患者恢复快、疗效满意.     

Transcatheter closure of large atrial septal defects in 18 patients

PURPOSE: This study was designed to evaluate the efficacy and safety of transcatheter closure of large atrial septal defects (ASD). METHODS: Eighteen patients diagnosed as ostium secundum defect with a diameter of 30-40 mm were enrolled in this study. With the guidance of echocardiography and fluoroscopy, the Amplazter occlusion devices were implanted percutaneously through the femoral vein. RESULTS: A small residual left-to-right shunt was detected with echocardiography immediately postprocedure but resolved after 1 week. The occlusion devices remained in proper position, and there was no residual shunt at 1- and 29-month follow-ups. Cardiac function and atrial sizes improved significantly as compared with the preclosure states. CONCLUSIONS: Transcatheter closure of large atrial septal defects with the Amplazter occlusion device is feasible, safe and effective.     

Surgical correction of double outlet left ventricle associated with hypoplastic right ventricle: direct anastomosis of right atrial appendage and pulmonary artery.

This reports concerns a 9 years old boy, who had situs solitus and atrioventricular concordance with double outlet left ventricle, pulmonary stenosis, tricuspid stenosis, ventricular septal defect, secundum atrial septal defects and hypoplastic right ventricle. Previous Blalock-Taussig shunt was created at the age of 11 months. Total correction consisted of closure of atrial septal defect and tricuspid valve orifice, and direct anastomosis of right atrial appendage to pulmonary trunk. Though atrial pacing was required for the immediate post operative period, the patient regained sinus rhythm 3 days after operation. He is doing well at present, one year after the operation.     

介入封堵术在老年继发孔型房间隔缺损患者中的临床应用

目的观察老年继发孔型房间隔缺损(ASD)患者进行介入封堵术的中、远期疗效和安全性。方法老年继发孔型ASD患者206例,缺损8～38(26.5±8.1)mm。封堵术前、术后行右心导管检测肺动脉压、右心室压,随访6个月,评价心功能(NYHA)改善情况。结果成功封堵203例,成功率98.5%。封堵器直径12～42(31.5±7.3)mm。与封堵术前比较,患者封堵术后肺动脉收缩压、右心室平均压明显下降(P<0.05,P<0.01);3～6个月随访时,患者右心室容积缩小、LVEF升高、心功能改善明显。术后心包积液1例(0.5%);即刻残余分流10例(4.9%);术后出现心律失常30例(14.8%)、出现急性心功能不全16例(7.9%)。6个月随访,患者均未发现有残余分流、脱落、栓塞。结论老年继发孔型ASD患者行介入封堵治疗中、远期相对安全、有效。     

Peratrial closure of atrial septal defects without cardiopulmonary bypass

The objective of this study was to introduce a new technique for occlusion of an atrial septal defect without cardiopulmonary bypass, using a modified Amplatzer device. Between October 2004 and November 2005, 96 secundum atrial septal defects in 83 patients were occluded by this method. A 3-cm incision in the right 4(th) intercostal space and a minithoracotomy were performed. Via this incision, the right atrium was exposed and the septal closure device was deployed under transesophageal echocardiographic guidance. The sizes of the defects ranged from 10 to 39 mm. The mean device size was 34.1 +/- 9 mm (12-46 mm). There was no operative mortality and no major morbidity on follow-up of 3-15 months. This new minimally invasive method of secundum atrial septal defect closure is safe and cosmetically superior to conventional surgery. Avoidance of cardiopulmonary bypass can reduce recovery time and complications. The indications are more extensive than percutaneous transcatheter closure, and the results are encouraging.