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patients, devices were not implanted, in two because the stretched diameter exceeded 26 mm and in three the device was withdrawn because it was unstable or compromised the mitral valve.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。     

Amplatzer device closure of femoral pseudoaneurysm after transcatheter aortic valve implantation: An alternative to surgical repair

Iatrogenic femoral artery pseudoaneurysm is an infrequent but troublesome complication of vascular access during transcatheter aortic valve implantation. There are non-invasive, percutaneous and surgical treatment options for management of this complication. This case series report demonstrates a novel technique using an Amplatzer Duct Occluder II closure device to successfully treat iatrogenic common femoral pseudoaneurysm following transcatheter aortic valve implantation.     

假性膜部瘤型室间隔缺损的介入封堵治疗

目的评价应用室间隔缺损封堵器闭合假性膜部瘤型室间隔缺损的可行性、安全性和疗效,并总结其技术难点与临床策略。方法2005-12/2008-12月,采用国产膜部室间隔缺损封堵器对37例假性膜部瘤型室间隔缺损行封堵治疗,封堵术前常规行左室造影,在经胸超声心动图及透视监测下通过建立股动静脉轨道、经右心系统释放封堵器,并于术后3、6、12个月随访复查胸片、超声心动图、心电图。结果37例假性膜部瘤型室间隔缺损患者全部成功行封堵术,技术成功率100%。其中11例采用封堵瘤体法,26例采用封堵左室面破口法。术后即刻发生少量残余分流3例,3个月随访时消失。结论应用室间隔缺损封堵器治疗假性膜部瘤型室间隔缺损疗效可靠,操作简便,使用安全。术中要根据假性膜部瘤型室间隔缺损的位置、形态、破口大小、数目等情况采用不同的封堵方法进行封堵,以达到最佳的治疗效果。     

Percutaneous PFO Closure with Amplatzer PFO Occluder: Predictors of Residual Shunts at 6 Months Follow‐up

Objective. The objective of this study was to assess predictors of residual shunts after percutaneous patent foramen ovale (PFO) closure with Amplatzer PFO occluder (AGA Medical Corporation, Golden Valley, MN, USA). Methods. All percutaneous PFO closures, using Amplatzer PFO occluder performed at a tertiary center between May 2002 and August 2006, were reviewed. Follow‐up, including saline contrast transesophageal echocardiography, was performed in all patients 6 months after the intervention. Patients. A total of 135 procedures were performed. Mean age of the patients was 51 years. The indication for PFO closure was an ischemic cerebrovascular event in 92%, paradoxical systemic embolism in 4%, and a diving accident in 4%. Recurrent events prior to PFO closure were noted in 34%. A concomitant atrial septal aneurysm was present in 61%. Results. At 6 months follow‐up, a residual shunt was detected in 26 patients (19%). Residual shunts were more common in patients with an atrial septal aneurysm (27 vs. 8%, P= .01) and in patients treated with a 35‐mm compared with a 25‐mm device (39 vs. 15%, P= .01). A concomitant atrial septal aneurysm remained independently associated with residual shunts when controlled for body mass index, gender, age, atrial dimensions, and presence of a Chiari network (odds ratio 4.1, 95% confidence intervals 1.1–15.0). Conclusion. The presence of atrial septal aneurysms in patients undergoing percutaneous PFO closure with an Amplatzer PFO occluder significantly increases the rate of residual shunts at 6 months follow‐up, even if 35‐mm devices are used.     

超声心动图在微创外科房间隔缺损封堵治疗中的应用

目的探讨超声心动图在微创外科房间隔缺损（ASD）封堵治疗中的应用价值。方法术前经胸超声心动图（TTE）筛选单纯继发孔中央型ASD95例,术中经食管超声心动图（TEE）进一步评估引导微创外科封堵治疗,术后3～6月TTE随访。结果95倒患者行ASD微创外科封堵术,封堵成功86例,占90．5％,9例封堵失败。TEE与TTE对ASD最大径及残缘测量值差异无统计学意义（P〉O．05）。房间隔伸展径TTE测量值大于TEE（P〈0．01）。TTE对上、下腔静脉缘的显示率为71．6％和77．8％,低于TEE（P〈0．01）。术后3～6个月1vrE随访,封堵器位置稳定,无移位,未影响周围瓣膜功能及静脉回流,1例有微量残余分流。右心重构改善,右房、右室内径较术前缩小,肺动脉血流速度降低（P〈0．01）。结论超声心动图贯穿了微创外科ASD封堵治疗的全程,TEE与TTE联合应用,对术前诊断与筛选、术中选择封堵器和实时监控、术后效果评价发挥了重要作用。     

Pulmonary edema following transcatheter closure of atrial septal defect

We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.     

封堵器介入治疗先天性心脏病的临床疗效及对心功能的影响

目的：探讨封堵器介入治疗先天性心脏病的临床疗效及对心功能的影响。方法：选择22例房间隔缺损（ ASD）、26例动脉导管未闭（PDA）及18例室间隔缺损（ VSD）患者为研究对象,采用封堵器介入治疗,观察临床疗效及治疗前后心功能指标的改变。结果：ASD、PDA及VSD成功率分别为100．0％、96．2％和94．4％。治疗后3月ASD、PDA及VSD组患者心功能指标显著改善（ P＜0．05）,其中PDA组LVESD、LVEDV 和LA显著改善, VSD 组LVESD 及LVEDV 显著改善, ASD 组RV、RA、LVESD 、LVEDV及LA均显著改善（P＜0．05）。结论：封堵器介入治疗先天性心脏病成功率高,疗效确切,治疗后患者心功能明显改善。