房间隔缺损介入治疗后随诊观察

目的评价房间隔缺损(ASD)介入治疗的近期及远期疗效。方法继发孔型ASD 428例,单一ASD 416例,多发ASD 12例,合并畸形70例。使用美国AGA-Amplatzer ASD闭合器及国产闭合器闭合ASD。结果428例ASD患者成功介入425例,介入技术成功率99.3%。介入手术并发症总发生率2.1%。合并畸形介入治疗成功率100%。425例患者介入后第2、3天行ECG、TTE及X线检查,均有不同程度的改善,其中225例患者于术后1个月、3个月、半年、1年以上进行心电图(ECG)、经胸超声心动图(TTE)及X线随诊,最长达6年。远期随诊主要症状为头痛,杂音消失80%。ECG不完全性右束支传导阻滞(IRBBB)在1年内可由72%降至3%,但ECG近期及远期效果心律失常发生率较高。TTE近期改变主要右室流出道(RVOT)及右室(RV)内径明显变小,远期随诊主要为房室瓣返流,均为轻度,残余漏仅1例,X线胸片心胸比值近、远期疗程均明显缩小。结论ASD介入治疗近期、远期疗效十分理想。

Follow-up outcome of percutaneous device closure of atrial septal defects

Objective To assess the follow-up outcome of patients who had a percutaneous closure of atrial septal defects(ASD).Methods Allof 428 consecutive patients with secundum ASD was included in the study.All ASD patients were central,including single ASD(n=416) and multiple ASD(n=12).In addition,70 patients accompanied other malformations.All 428 consecutive adult patients underwent percutaneous transvenous secundum ASD occlusion using the AGA-Amplatzer device or ASD occluder made in China.Results Devices were successfully implanted into 425(99.3%) of 428 patients.Total complications rate was 2.1%.The cure rate of malformations was 100%.Follow-up evaluation was performed in 425 successful patients by electrocardiogram(ECG),transthoracic echocardiography(TTE) and X-ray at 48 to 72 hours,1,6,and 12 months after occlusion,the maximum follow-up period was 6 years.225 of 425 patients had complete follow-up data.Murmurs disappeared in 80% of the 225 patients,electrocardiogram showed that incomplete right bundle branch block(IRBBB) rate reduced from 72% to 3% in 1 year of procedure,echocardiogram displayed that right ventricular outflow tract(RVOT) and right venticle(RV) diameter reduced significantly,X-ray revealed a significant reduction of cordis/thorax ratio.Early complications were mainly arrhythmia,including sinus bradycardia,sinus tachycardia and premature contraction.Late complications were residual shunting and trivial atrioventricular insufficiency,no significant regurgitation was noted.Conclusion This single-center experience with percutaneous device closure of ASD demonstrates excellent results with few early and late complications.