国产封堵器治疗边缘不足的房间隔缺损的效果观察

目的 探讨使用国产封堵器治疗边缘不足(<5 mm)的继发孔型房间隔缺损(ASD)的可行性及近期疗效.方法 27例边缘不足的继发孔型ASD患者术前经胸或经食管超声心动图测得缺损最大直径平均为(22.89±8.08)mm,根据ASD边缘不足分为前缘(主动脉缘)不足型、后缘(主动脉对侧缘)不足型、下缘(下腔静脉缘)不足型及复合不足型,分别制定封堵策略,用国产封堵器经导管或经右胸小切口进行封堵治疗.分别于术前、术后48～72h及3个月时经胸超声心动图观察封堵器位置及有无分流,同时测量右心大小以观察疗效.结果 本组中前缘不足型20例(0～4 mm),下缘不足型3例(1～4 mm),后缘不足型1例(2 mm),复合不足型3例(前缘、下缘均<5 mm).27例ASD患者中成功封堵26例,1例术后1 h发现封堵器脱落改行直视修补术,成功率96.3%(26/27).26例患者封堵后右房及右室内径较封堵前明显缩小(P<0.01),无介入操作相关并发症发生.结论 前缘、后缘或下缘<5 mm的继发孔型ASD可用国产封堵器封堵治疗,且安全、有效、并发症少、费用低.

Effect of domestic-made occluder device in the treatment of atrial septal defect with edge-insufficiency

Objective To evaluate the feasibility and effect of the domestic-made occluder device in blocking secundum atrial septal defect(ASD)with edge-insufficiency(<5 mm).Methods Twenty-seven patients with edge-insufficiency were measured by transthoracic and transesophageal color Doppler echocardiography preoperatively.and the most expanding defect diameter was(22.89±8.08)mm.According to the edge-insufficiency conditions,defects were divided into anterior edge-insufficiency(aortic edge),posterior edge-insufficiency(aortic contralateral edge),inferior edge-insufficiency(inferior vena cava edge)and complex type.Domestic-made occluder device was selected to adapt for corresponding type.The position of occluder device and shunt were observed by echocardiography at 48-72 hours and the 3rd month after operation.Meanwhile the size of right heart was measured.Results The anterior edge-insufficiency type was20 cases(0-4 mm),inferior edge-insufficiency type was 3 cases(1-4 mm),posterior edge-insufficiency type was 1 case(2 mm)and complex type was 3 cases(<5 mm).Devices were successfully deployed in 26patients.1 patient whose device exfohated 1 hour after operation accepted reoperation in euthyphoria.Successful rate was 96.3%(26/27).The size of right atrium and ventricle postoperation reduced significantly compared with peroperation(P< 0.01).There was no complication in all patients.Conclusions Secundum ASD with anterior,inferior and posterior edge-insufficiency(< 5 mm)can be occluded by domestic-made occluder device.It is safe,effective,with fewer complications and lower-cost.