双封堵器介入治疗多孔性房间隔缺损

目的对双封堵器介入治疗多孔性房间隔缺损(ASD)的可行性与有效性进行临床评估。方法对17例多孔性ASD(12例为2孔,5例为3孔)患者在X线透视和超声心动图监测下植入Amplatzer封堵器,同时闭合2～3个缺损。术后复查ECG、X线平片及TTE以评价其疗效。结果 17例术中超声测量ASD大、中和小缺损直径分别为(13.94±3.21)mm、(9.65±2.64)mm及(4.80±1.92)mm。16例获得成功(16/17,94.12%),1例因第2个ASD不适于封堵而放弃,改行外科手术后痊愈出院。16例植入封堵器32枚,共闭合缺损37个,所植入大、小封堵器直径分别为(20.75±4.07)mm和(16.94±3.75)mm,较术中超声所测大孔及中孔ASD径分别增大(7.06±2.65)mm、(7.44±3.25)mm。术后3例残余微或少量分流(2例为3孔ASD),分别于术后第2、3天及3个月复查时消失。1例发生股动静脉瘘,1个月后消失。随访X线胸片测心胸比及超声测右心室前后径均较术前明显下降(P均<0.01)。结论采用双封堵器介入治疗多孔性ASD安全、有效。

Transcatheter closure with double Amplatzer septal occluder device in treatment of multiple atrial septal defects

Objective To evaluate the clinical feasibility and effectiveness of transcatheter closure of multiple atrial septal defects (ASD) using double occluders. Methods Seventeen patients underwent transcatheter closure of multiple ASD (2 or 3) with double devices under X-ray fluoroscopy and TTE. Electrocardiogram, X-ray chest radiography as well as echocardigraphy were performed to evaluate the effectiveness after the procedure. Results All patients had multiple ASD (12 with 2 defects and 5 with 3 defects) . TTE during the procedures showed that the mean diameters of the larger, medium and smaller defects was (13.94±3.21)mm, (9.65±2.64)mm and (4.80±1.92)mm, respectively. Tanscatheter closure of multiple ASD succeeded in 16 patiets (16/17, 94.12%), 1 failed because the second defect was not suitable for intervention, and was cured by surgery, and totally 32 occluder devices were implanted and closed 37 defects. The mean diameters of the larger and the smaller occluders was (20.75±4.07)mm and (16.94±3.75)mm, respectively, larger than the value showed by TTE during procedures by (7.06±2.65)mm (larger defects) and (7.44±3.25)mm (medium defects). Immediately after the procedure, 3 patients had trivial shunt (2 patients with 3 defects), which disappeared 2, 3 days and 3 month later, respectively. No severe complication occurred, while femoral arteriovenous fistula was observed in 1 patient and disappeared 1 month later. The cardiothoracic ratio of X-ray chest radiography and the right ventricle internal diameter measured by echocardiography dropped during follow-up (all P<0.01). Conclusion Transcatheter closure of multiple ASD with double devices is feasible, safe and effective.