单纯超声引导下经颈静脉途径封堵婴幼儿房间隔缺损临床疗效

目的探讨超声引导下经颈内静脉途径封堵婴幼儿房间隔缺损(atrial septal defect,ASD)的技术要点、适应证与安全性。方法回顾性分析2017年1月至2019年5月在阜外医院接受单纯超声引导经颈静脉途径封堵治疗53例ASD婴幼儿的临床资料,其中男20例、女33例,年龄1.2(0.5~2.9)岁,体重9.0(6.8~10.6)kg,ASD直径9.8(8.0~14.0)mm。31例患者在经食管超声心动图引导下完成治疗,其余22例患者在经胸超声心动图引导下完成治疗。在超声引导下,使用可调弯鞘经颈内静脉、选择合适型号的封堵器进行封堵,封堵器直径(13.5±4.5)mm。结果53例患者全部封堵成功,均无中转放射线引导或开胸手术。术后住院时间(3.35±0.70)d,无外周血管损伤、封堵器脱落、严重心律失常或心包积液等并发症。随访(14.3±5.1)个月,无心律失常、残余分流、封堵器脱落、血栓发生。结论超声引导下经颈内静脉途径封堵ASD对于低体重、ASD分流大的婴幼儿或下腔静脉异常不适宜经股静脉治疗的患者,不仅克服了射线引导的辐射风险,同时保持了微创、安全的优点,为此类患者提供了新的治疗选择。

Clinical efficacy of trans-jugular transcatheter closure of atrial septal defect solely under echocardiography guidance in infants

Objective To explore the key points,indications and safety of trans-jugular transcatheter closure of atrial septal defect(ASD)in infants.Methods The clinical data of 53 infants with ASD from January 2017 to May 2019 in our hospital were retrospectively reviewed.There were 20 males and 33 females with the age of 1.2(0.5-2.9)years,and body weight of 9.0(6.8-10.6)kg.The ASD diameter was 9.8(8.0-14.0)mm.Thirty-one patients were treated under the guidance of transesophageal ultrasound(TEE),and the other 22 patients under the guidance of transthoracic echocardiography(TTE).We used the steerable curved sheath through the internal jugular vein under the guidance of echocardiography,and the average occluder size was 13.5±4.5 mm.Results All of the 53 patients were successfully occluded,and none of them changed to radiation-guided or transthoracic surgery.Postoperative hospital stay was 3.35±0.70 d.There was no complication such as peripheral vascular injury,occluder malposition or displacement,serious arrhythmia or pericardial effusion.The patients were followed up for 14.3±5.1 months without arrhythmia,residual shunt,occluder malposition or displacement or thrombus.Conclusion Echocardiography-guided trans-jugular closure of ASD for infants with low weight and large ASD shunt or patients with inferior vena cava abnormalities not suitable for femoral vein treatment,not only overcomes the radiation risk of radiation guidance,but also maintains the advantages of minimal invasiveness and safety,providing a new treatment option for such patients.