导管消融术后医源性房间隔缺损的临床研究进展

随着心房颤动导管消融手术应用的日益增多,消融后医源性房间隔缺损的发生率可能将进一步增加。医源性房间隔缺损的预测因素已有相关报道,但持续性医源性房间隔缺损的临床意义尚不明确,是否需要对消融后出现的房间隔缺损进行封堵或者严格的监测亦无定论。本文就导管消融术后医源性房间隔缺损的发生情况、预测因素、临床意义以及治疗进行综述。     

体外膜肺氧合联合经皮房间隔造口术治疗儿童暴发性心肌炎1例

暴发性心肌炎是儿童危急重症之一,发展迅猛、病死率高。该文报道1例暴发性心肌炎、心原性休克的患儿,在积极抗休克、纠正心律失常、免疫调节、器官支持等治疗的基础上联合体外膜肺氧合支持、呼吸机辅助通气及经皮球囊房间隔造口术被成功救治。采用经皮房间隔造口术治疗儿童暴发性心肌炎罕见报道,该病例可为临床提供参考。     

手术治疗60岁以上房间隔缺损患者的经验

<正> 房间隔缺损是先天性心脏病中常见疾病之一,老年房间隔缺损患者手术治疗有其特殊性。现将我院17例60岁以上房间隔缺损患者手术及围手术期处理的经验报道如下,旨在为临床提供一定的指导。 1 资料与方法 1.1 研究对象选择2000年4月～2007年12月在我院心胸外科手术治疗的60岁以上房间隔缺损患者17例,其中男6例,女11例,年龄60～65(62.8±2.1)岁。均于胸骨左缘     

房间隔缺损介入治疗现状与未来

房间隔缺损为常见的先天性心脏病,介入治疗已成为房间隔缺损主要的治疗方法,随着封堵器及传送装置的发展,临床应用越来越广泛,治疗的对象及手术并发症逐渐受到重视,现就房间隔缺损介入治疗现状和进展做一综述.     

房间隔缺损修补术后下腔静脉引流入左房

房间隔缺损是一种常见的先天性心脏病，外科手术修补缺损是治疗畸形的基本手段。然而，手术不当可导致新的畸形、房间隔修补术后下腔静脉异位引流人如左房。特报道如下。患者，女性，36岁，住院号：Yto12，患者自幼出现心脏杂音，对年前因房间隔缺损在某医院行房间隔缺损修补术     

经颈静脉路径封堵房间隔缺损合并下腔静脉肝下段缺如一例

该文报道1例房间隔缺损合并下腔静脉肝下段缺如畸形患者,采用经颈静脉-上腔静脉途径构建轨道,进行介入封堵治疗。患者术后1、3个月时复查结果良好。房间隔缺损合并下腔静脉肝下段缺如患者可选择介入封堵治疗,推荐经颈静脉途径进行操作,其安全性及治疗效果良好。     

超声心动图在房间隔缺损介入封堵治疗术的应用进展

介入封堵术已成为临床上治疗继发孔型房间隔缺损首选的治疗方法,超声心动图在术前选择病例、确定封堵器型号、术中监测以及术后随诊方面具有重要的临床价值。现就其在介入封堵术中的应用进展做一综述。     

国产封堵器治疗先天性心脏病55例

近年国内学者应用国产封堵器经导管封堵治疗动脉导管未闭(PDA)、继发孔型房间隔缺损(ASD)和室间隔缺损(VSD),其良好疗效和安全性已得到公认,使先天性心脏病的介人治疗迈上一个新台阶.我院近期采用该方法治疗PDA、ASD和VSD取得良好疗效,报道如下.     

先天性心脏病介入治疗的现状与争议

<正>自1967年Porstmann等首次报道经心导管封堵动脉导管未闭以来,利用介入方法治疗其他心内缺损,如房间隔缺损、室间隔缺损、动脉导管未闭等已有近30年的历史。King和Rashkind分别于1974、1977年成功实现了介入治疗房间隔缺损     

三维食管超声心动图在经胸小切口房间隔缺损封堵术中的应用

目的：探讨实时三维经食管超声心动图（RT-3D TEE ）在监测经胸小切口房间隔缺损（ASD ）封堵术的作用。方法初步筛查适合封堵术的ASD患者30例,缺损大小6mm～32mm ,房间隔残缘≥5mm。术前采用经胸超声心动图（TTE）重点测量房间隔总长度、房间隔缺损的最大径、房间隔残缘软边的长度;术中采用RT-3D TEE监测,并测量房间隔总长度、房间隔缺损的最大径、房间隔残缘软边的长度,与术前检查结果进行比较。术后1～12个月进行随访。结果30例经胸小切口ASD封堵术全部成功,没有出现需要进一步处理的意外。经食管超声心动图（TEE ）在识别房间隔总长度、软边长度方面均优于TTE ,两者在测量房间隔缺损最大径方面无统计学意义,RT-3D TEE成像显示房间隔缺损立体影像图。结论经胸小切口ASD封堵术中应用经食管超声心动图对于选择合适病例、封堵器型号、指导封堵过程以及疗效评价方面具有重要作用并优于经胸超声心动图,配备实时三维成像功能检查效果更理想。     

Frequency of circumferential pericardial effusion by echocardiography in adults with foramen ovale type atrial septal defect versus ventricular septal defect

Many published reports have described pericardial effusions in patients with secundum atrial septal defects. This study investigated their associated prevalence echocardiographically using 40 patients with isolated ventricular septal defects as controls in an adult patient population. Pericardial effusions accompanied atrial septal defects in 13 patients and ventricular septal defects in only 3 patients (p <0.0001). In conclusion, pericardial effusions are much more common (p <0.005) with uncomplicated secundum atrial septal defects than with uncomplicated ventricular septal defects.     

Successful treatment of left atrial disk thrombus on an Amplatzer atrial septal defect occluder with abciximab and heparin

Acute device thrombosis is a rare but important complication after transcatheter atrial septal defect closure. In this case a mobile thrombus was noted on the left side of an Amplatzer atrial septal occluder after device release in a 12 year old boy with an uncomplicated atrial septal defect. The thrombus was successfully treated with an infusion of heparin and the glycoprotein IIa/IIIb receptor antagonist abciximab. Transoesophageal ultrasound performed the following day showed complete resolution of the clot. There are no reports to guide treatment of acute thrombosis in this setting. This combination of treatments was effective without complication in this case.     

Transcatheter closure of atrial septal defects in adults using two devices: an angiographic overview.

Atrial septal defects are a common congenital cardiac abnormality in adults. lndividuals with atrial septal defects carry the risk to develop cardiac problems such as right ventricle volume overload, pulmonary hypertension, atrial fibrillation, and more rarely paradoxical embolic events. Surgery was the standard treatment for symptomatic patients with atrial septal defects for decades. More recently, percutaneous transcatheter closure of atrial septal defects in adults using a closure device has become an alternative to surgery in selected patients.     

Congenital heart disease in Down's syndrome patients: a decade of surgical experience

Patients with Down's syndrome represent a significant subset of patients with congenital heart disease. Fifty-five patients with Down's syndrome have undergone surgical treatment for congenital heart disease at our institution in the past decade. Twenty-six had atrioventricular canal, 11 had ventricular septal defect, 7 had secundum atrial septal defect, 7 had tetralogy of Fallot, 3 had primum atrial septal defect and 1 patient had double outlet right ventricle. The thirty day mortality following operative intervention was 16.4%. Mortality was highest for tetralogy of Fallot followed by atrioventricular canal and ventricular septal defect. Long term mortality for all lesions was 27.3% over our follow-up period which averaged 33 months. Thirty day mortality compared similarly to previous reports of surgically treated Down's syndrome patients. When compared to our patients without Down's syndrome, the Down's population did not exhibit an increased risk for surgical treatment of congenital heart disease.     

A patient with an unusual cyst of the inter‐atrial septum and atrial sepal defect

Hepatic and renal cysts are relatively common among healthy people, but there are few published reports of primary cysts of the atrial septum. Here, we report a case of an unusual cyst of the atrial septum accompanied by atrial septal defect (ASD) in a 42‐year‐old woman. Microscopic examination showed the deposition of calcium salts within the tissue mass and an organized thrombus surrounded by a fibrous capsule. The case was discussed with reference to the relevant published literature and compared to other documented types of atrial septal cysts. The final diagnostic conclusion was a primary atrial septal cyst.     

Radiologic findings of 2 commonly used cardiac septal occluders with clinical correlation

Transcatheter closure of an atrial septal defect, patent foramen ovale, or post-myocardial infarction ventricular septal defect has become a safe and effective alternative to medical and surgical therapy. Although the use of transcatheter closure of septal defects is becoming increasingly more popular, there are few reports of the radiographic appearance of the closure devices. We report the chest radiographic findings in 36 patients after transcatheter closure of septal defects with Amplatzer or CardioSEAL occluders in an effort to aid radiologists in recognizing the appearances of these devices and enable them to confirm proper positioning.     

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.     

Atrial septal pacing in the prevention of paroxysmal atrial fibrillation refractory to antiarrhythmic drugs

BACKGROUND: Early reports have shown that pacing the atria at a site or sites other than the right atrial appendage may prevent atrial fibrillation. Our centre has shown that pacing the atrial septum reduces the duration of atrial activation which is an important determinant of predisposition to paroxysmal atrial fibrillation. Ablation of the atrioventricular (AV) node together with implantation of a pacemaker can control symptoms due to paroxysmal atrial fibrillation in patients in whom antiarrhythmic drugs have failed. The aim of this study was to investigate the effect of atrial septal pacing on patients who were candidates for AV node ablation. METHODS: Atrial septal pacemakers were implanted in 28 patients with symptomatic, paroxysmal atrial fibrillation that had been unresponsive to two or more antiarrhythmic drugs. Pacing was not indicated for any reason other than the anticipated need to proceed to AV node ablation. Change in symptoms was assessed by quality of life questionnaires and recurrence of atrial fibrillation was measured objectively by pacemaker interrogation and ambulatory electrocardiographic monitoring. RESULTS: Atrial septal pacing in combination with an antiarrhythmic agent resulted in a substantial subjective improvement in 19 patients (68%). Objective data confirmed similar findings; atrial fibrillation was completely or markedly reduced in 17 patients (60%). Six patients experienced a modest improvement in symptoms; in only four patients was it necessary to proceed to AV node ablation. CONCLUSIONS: Atrial septal pacing together with continuance of previously ineffective antiarrhythmic therapy may prevent or markedly reduce the frequency of paroxysmal atrial fibrillation and obviate the need to ablate the AV node.     

Congenital tricuspid valve stenosis with atrial septal defect and left anterior fascicular block

Congenital tricuspid valve stenosis in the absence of other valvular abnormalities is rare. In this report we describe a patient with congenital tricuspid valve stenosis, ostium secundum atrial septal defect, and electrocardiographic left anterior fascicular block, who presented with paradoxical emboli. This case, as well as previous case reports, suggests that congenital tricuspid stenosis with ostium secundum atrial septal defect is associated with left anterior fascicular block.     

Atrial septal defects: problems in adults

The clinical features of atrial septal defects in adults have changed due to the generalisation of surgery of the anomaly in childhood and the widespread use of transoesophageal echocardiography. Rare complications, such as paradoxical embolism or cerebral abscess, can now be more reliably attributed. Pulmonary hypertension, a feared traditional complication, is better understood: the severe form with right-to-left shunting (Eisen-menger's syndrome) occurs rarely in young adults, with a probable genetic predisposition; the less severe form, with persistence of a large left-to-right shunt is observed more often in adults over 50 years of age, and closure of the atrial septal defect remains beneficial over a long period of time. It has now been shown that this repair, even when performed late, improves symptoms but with less effect on atrial arrhythmias. Percutaneous closure is the treatment of choice and surgery is only considered after failure of endocavitary closure. The indication for closure of small atrial septal defects remains the subject of controversy.