右胸小切口封堵缺乏边缘的Ⅱ孔型房间隔缺损

目的 评估右胸小切El封堵缺乏边缘房间隔缺损的可行性和安全性.方法 2005年11月至2007年11月.25例1-2个边缘完全缺乏的病人行右胸小切口房间隔缺损封堵手术,女15例,男lO例;年龄5.64岁,平均28.8岁.其中单纯前边缘缺乏11例,前边缘合并下边缘缺乏3例,前边缘合并后边缘缺乏4例,后边缘缺乏l例,前边缘合并上边缘缺乏l例.单纯上边缘缺乏4例,静脉窦型房间隔缺损1例.后边缘和下边缘缺乏者使用4-o pmlene线在心脏外面贯穿缝合固定封堵器;后边缘缺乏在房间沟偏右房侧缝合2针固定;下边缘缺乏者在右心房靠下腔静脉和右下肺静脉处缝合l针固定;静脉窦型房间隔缺损在左心房顶以4-o prolene线作2针间断缝合,在上腔静脉后壁作1针间断缝合,释放封堵器后,推拉试验检查是否牢固.以5-4例Ⅱ孔型房间隔缺损有充分边缘者(>5衄)行右胸小切El房间隔缺损封堵治疗者作为对照组,其中女36例.男18例,平均年龄31.9岁(5-72岁).结果 无边缘组房间隔缺损直径10-38衄,平均(23.3±8.5)mm.封堵器大小为(27.9±7.8)mm(14-42衄).对照组房间隔缺损直径9.38衄,平均(23.6±7.0)mm,封堵器大小为(29.4-I-7.3)r唧(12-42m).两组房间隔缺损直径和所用封堵器大小差别无统计学意义(P>O.05).平均手术时间分别为(30±7)min和(15 4-4)rain.差别有统计学意义(P<0.c15).25例缺乏边缘者100%(25,25例)封堵成功,对照组96%(52,54例)封堵成功,2例存在轻度残余分流.随访6个月,两组封堵成功率均为100%,均无严重并发症.结论 右胸小切口可以成功封堵边缘缺乏的房间隔缺损,但需要更长期的随访评估长期的安全性和有效性.

Intraoperative device closure of secundum atrial septal defect associated with deficient rims with a right anterior minithora-cotomy

Objective To evaluate the feasibility of inrtaoperative device closure of secundum atrial septal defects(ASDs) as-sociated with deficient rime using the china-made septal occluder through a right antierior minithoractomy.Methods 25 patients with deficient rims underwent an attemptes intraoperative device closure.The patients had a deficient anterior rim (n=11),a deficient anterior rim and an inferior rim (n=3),a deficient anterior rim and a posterior rim(n=4),posterior rim(n=1),deficient anterior rim and superior rim(n=1),superior rim(n=4)as assessed by transesophgeal echocardiography(TEE).54 patients with sufficient rims(>5mm)who underwent closure served as controls.For deficient inferior rim,a sticth was sewed at the inferior vena cava near right infrior pulmonary vein to enforce the umbrella.For deficient posterior rim,a sticth was sewed at the right atrium to enfoce the umbrella.Results There were no differences between the 2 grouos in ASD stretched diameter and devioe (P>0.05).Of 25patients with deficient rims,25(100%)had immediate complete closure compared with 52 of 54 patients (96%) with sufficient rims (P<0.05).At 6-month follow-up,the complete closure rates were not significantly different between the 2 groups(100% for pa-tients with deficient rims vs 96%for patients with sufficient rims at 24 hours and 100% vs 100%at 6months,respectively).The procedure time were longer in patients with deficient rims[(30±7)minutes],compared with the those with sufficient rims[(15±4)minutes].No major complications were encountered either duringor after the closure procedure in both groups.Conclusion Intraop-erative device closure of secundum atrial septal defects seeociated with deficient anterior,inferior,or posterior rims is feasible using the china-made septal occluder through a right antierior minithoractomy.Long-term follow-up dsta are still needed to assess long-term safety and diicacy.