介入治疗房间隔缺损600例临床分析

目的:探讨介入治疗房间隔缺损(ASD)的疗效及并发症。方法:1998年11月至2011年2月应用双盘伞ASD封堵器治疗600例继发孔ASD,其中男性235例,女性365例;年龄1.3~72岁,体质量10~107kg。术前均经体检、心电图、胸X线片及超声心动图确诊,术后行心脏超声及临床检查随访。结果:手术成功率98.8%(593/600),5例因缺损较大或边缘不足试封堵失败,1例术中出现Ⅲ°房室传导阻滞放弃介入治疗,1例释放封堵器后即发现移位,即刻通知外科及时开胸取出封堵器并修补缺损;选择封堵器直径6~40mm,35例多孔ASD,有33例置入1个封堵器,2例应用2个封堵器。手术近期并发症包括:封堵器移位(1例),脑梗死(1例),心律失常(2例),空气栓塞(3例),平均5年随访中没有严重并发症。结论:ASD的介入治疗其技术成功率高,近期和远期疗效均满意,已成为治疗ASD的首选方法。

Transcatheter closure of atrial septal defects in 600 cases

Objective：To evaluate the efficacy and complication of transcatheter closure of secundum atrial septal defects （ASD）.Methods：600 consecutive patients （235male,365female）with a significant ASD （age1.3years to 72 years; body weight 10-79 kg） were considered for transcatheter closure from Nov 1998 to Feb 2011.All of them were confirmed by physical examination,ECG,X-ray and transthoracic echocardiography.Results：At cardiac catheterisation,devices were not implanted in 7 patients because the stretched diameter of the ASD was too large （n =5）,device malposition （n =1）,or complete heart block（n =1）.The ASD closure was done successfully in 593 patients,the diameter of the devices ranged between 6-40 mm,among whom 35 had multiplc ASDs,33 cases implanted only one occluder,another 2 cases were closed by implanting two occluders.Severe procedure related complications include：device malposition （n =1）,cerebral embolism（n =1）,complete heart block（n =2）,air embolism（n =3）.At follow up （median 5 years）,there were no severe complications.Conclusion：The transcatheter closure of ASD is very efficient and offered with excellent intermediate and long term results.