Infective endocarditis after device closure of atrial septal defects: Case report and review of the literature

We report a case of late infective endocarditis in an 8‐year‐old boy 3 years after transcatheter closure of an atrial septal defect with the Amplatzer Atrial Septal Occluder Device. Echocardiography showed a very thick pannus lining the left atrial disc of the prosthesis, with some mobile elements. MRI showed several cerebral microemboli. The patient had dental caries and blood cultures found Staphylococcus aureus. Patient was treated with gentamicin and oxacillin before surgical removal of the prosthesis. Twenty‐one cases of infective endocarditis after atrial defect device closure have been reported in the literature (13 ostium secundum ASD and 8 patent foramen ovale). Seven pediatric cases were reported. S. aureus was the most frequent bacterium. Antibiotics were administered in all cases and most patients (n = 18) underwent surgical removal of the device. Incomplete endothelialization of the prosthesis was a suggested mechanism. Two patients died after surgery. © 2016 Wiley Periodicals, Inc.     

经胸小切口房间隔缺损封堵术41例报告

目的探讨经胸小切口房间隔缺损封堵术治疗房间隔缺损（atrial septal defect,ASD）的疗效。方法胸骨右旁第4肋间切口长3～4 cm,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,在经左胸壁或食道超声监视下,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,再做一针贯穿右房壁和伞边缘的褥式缝合固定。结果39例成功封堵,手术时间45～95min,平均60 min;术后住院3～6 d。术后2～24个月复查,心脏彩超检查封堵伞无移位,无残余分流。2例封堵不成功术中转开胸体外循环下完成手术。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。     

经导管封堵治疗室间隔缺损的临床应用

目的:探讨经导管途径治疗室间隔缺损(VSD)的可行性及近期疗效。方法:2003年12月至2005年3月采用VSD封堵器对13例(男8例,女5例)VSD(4例合并膜部瘤)患者进行封堵治疗。患者年龄4~35岁,平均(15.2±10.7)岁,胸部超声提示VSD的直径为4~12 mm,平均(5.4±1.2)mm。在X线透视及超声监视下通过建立轨道、经右心系统释放封堵器,并分别于术后1、3和6个月进行随访。结果:12例患者封堵器置入成功,成功率为92%。术后即刻超声及造影显示完全封堵11例,微量残余分流1例,10 min后造影显示分流消失。术后出现完全性右束支传导阻滞1例,但无心肌受损表现,余无其他严重并发症。1例嵴内型VSD由于距主动脉较近,封堵未成功。结论:采用经导管途径治疗VSD是安全有效的、近期效果良好,但远期效果有待更大规模的临床观察。     

经导管介入治疗动脉导管未闭的疗效评价

目的观察经导管封堵器治疗动脉导管未闭(Patentductusarterious,PDA)的临床疗效。方法对31例PDA患者应用国产蘑菇伞动脉导管封堵器,经静脉途径行封堵治疗,合并肺动脉瓣狭窄者,先行球囊扩张术,再行PDA封堵治疗;合并房间隔缺损者,先行PDA封堵治疗,后行房间隔缺损封堵术。术后即刻X线造影观察疗效,24h、1个月、3个月、1年应用超声心动图评价治疗效果。结果31例患者植入封堵器均获成功,全组技术成功率100%;术后肺动脉平均压较术前明显下降。术中无任何严重并发症,随访1个月至3年,未发现残余分流、封堵器移位、溶血、血栓或主、肺动脉狭窄。结论经导管法介入治疗PDA,安全有效,创伤小,成功率高,操作简单。     

膜周部室间隔缺损介入治疗的临床评价

目的:评价膜周部室间隔缺损(VSD)经导管封堵治疗的临床效果。 方法:456例患者,经胸超声心动图测量VSD直径为3-18(6.2±3.1)mm,VSD距主动脉右冠瓣距离0.5-5.0(2.3±1.0)mm。其中6例合并动脉导管未闭,7例合并房间隔缺损,1例合并动脉导管未闭和房间隔缺损。19例伴轻度主动脉右冠瓣脱垂。先行左心室造影,通过VSD建立动静脉轨道,应用7-10F输送鞘管从右心系统送入封堵器。 结果:左心室造影测量VSD直径为3-20(6.4±3.0)mm,VSD距主动脉右冠瓣距离0.5-6.0(2.4±1.1)mm,其中86例患者VSD距主动脉右冠瓣距离<2 mm。391例伴膜部瘤形成。448例患者封堵成功,成功率为98％。未成功的8例中,2例导管未能通过缺损处,2例术中导丝通过VSD出现Ⅲ度房室传导阻滞(AVB),2例封堵后出现间歇性Ⅲ度AVB,2例伴主动脉右冠瓣轻度脱垂患者封堵后有少-中量主动脉瓣反流而放弃封堵治疗。所选封堵器大小为4-22(8.6±3.1)mm。封堵器到位后即刻左心室造影示微量残余分流68例,6个月复查超声心动图有1例微量残余分流。术后发生高度AVB 6例,1例安装永久起搏器。封堵器向膜部瘤出口明显移位1例,外科取出封堵器并行手术修补VSD。溶血2例,三尖瓣中量反流1例。合并动脉导管未闭6例、房间隔缺损7例、合并动脉导管未闭和房问隔缺损1例,同时成功封堵。 结     

房间隔缺损介入封堵术的三维可视化模拟

目的探讨用三维可视化技术来模拟房间隔缺损介入封堵治疗术的方法。在术前模拟封堵治疗结果,以选取合适的封堵器或判断是否适合做封堵手术。方法对病小儿心脏用超声三维数据体绘制的方法进行可视化,同时用三维建模技术模拟封堵器以及其在房间隔缺损中的形态。结果超声三维可视化技术可以清晰地看到房间隔缺损的形态以及大小,而利用模拟技术可以任意选择封堵器的大小并显示封堵术的结果,在术前对医生的判断可以起到一定的辅助作用。讨论本文提出的方法显示速度快,且三维显示清晰准确,可以作为介入治疗术前指导的辅助手段。     

房间隔缺损经导管封堵术对心率变异性的影响及意义

目的探讨房间隔缺损(ASD)经导管封堵术对心率变异性(HRV)的影响及意义。方法选择成功接受介入治疗的ASD患者118例为研究对象(ASD组),分别于术前1天及术后第4天记录24h动态心电图,由电脑自动分析并经心电专业人员校正,得出HRV的各项时域指标;另按术前心脏超声测得的肺循环血流量/体循环血流量(Qp/Qs)分为Ⅰ组(Qp/Qs<1.5)与Ⅱ组(Qp/Qs≥1.5),分析两亚组患者HRV,并行Qp/Qs与HRV的相关性分析。结果与对照组比较,ASD组封堵术前后24hRR间期标准差(SDNN)及24h内每5min节段RR间期均值标准差(SDANN)均显著降低(P<0.01或0.05);Ⅱ组降低更明显。ASD组封堵术后RR间期、SDNN及SDANN均较术前增加(P<0.05);Ⅱ组介入治疗术后的SDNN、ASDNN较Ⅰ组术后明显减小(P<0.05)。ASD患者术前SDNN及SDANN与Qp/Qs呈负相关(r值分别为-0.528、-0.644,P<0.01)。结论ASD封堵术后HRV水平明显恢复;Qp/Qs越大的ASD患者不仅术前HRV水平降低更显著,术后的恢复也越慢。     

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.     

可降解封堵器治疗先天性心脏病的研究进展

应用封堵器经皮介入治疗已经成为大部分常见先天性心脏病如房间隔缺损、室间隔缺损、动脉导管未闭等的首选根治疗法。目前临床使用的封堵器大多为镍钛合金金属封堵器,被植入人体后将永久存在,并有机体慢性炎症、心脏穿孔及高度传导阻滞等严重并发症风险。可降解封堵器植入体内后可逐渐被自身组织替代。研究者不断探索使用不同可降解材料研制可降解封堵器,其中由张智伟教授团队主持研制的Absnow™完全可降解房间隔封堵系统已于2018年获得广东省药品监督管理局(GDMPA)批准进入临床试验阶段,成为全球首款进入临床试验阶段的完全生物可降解房间隔缺损封堵装置。人体预试验结果显示,该封堵器应用于人体具有初步的安全性和有效性,但尚需多中心临床试验进行评估验证。选择合适的可降解材料研制新型可降解封堵器以及封堵器的有效性及安全性研究,仍然是目前可降解封堵器治疗先天性心脏病相关研究的焦点和发展趋势。     

国产双伞形封堵器治疗多发性巨大肺动静脉瘘

多发性肺动静脉瘘一直是临床治疗的难题,介入放射技术应用于该疾病的治疗以来,取得了较为满意的临床疗效,但使用的栓塞材料种类较多,栓塞性能各不相同,有些材料在应用过程中还发现很多问题,甚至出现异位栓塞等严重并发症,这些问题往往和栓塞材料的设计缺陷以及对疾病的病理特点认识不足有关。