两种不同方法选择封堵器型号在小儿房间隔缺损介入治疗中的应用比较

目的 探讨房间隔缺损（ASD）介入治疗中封堵器型号选用依据,评价不同大小封堵器对心脏重构及心功能改变的影响.方法 选取ASD患儿46例,分为A、B两组各23例.A组应用椭圆周长公式计算等效圆直径,依该直径加1～2 mm选封堵器型号;B组按经胸超声（TTE）测量最大径加2～4mm选封堵器型号.TTE测量术前、术后1个月、3个月、6个月右房、左房收缩末径（RALD、LALD）、右室、左室舒张末径（RVDD、LVDD）,计算RALD/LALD、RVDD/LVDD.测量封堵器厚度、左室射血分数（LVEF）.结果 A组缺损直径为（16.56 ±4.23）mm,B组为（17.22±5.08）mm,两者无明显差异.A组封堵器直径为（19.18±5.29）mm,B组为（22.37±6.16）mm,其差异有统计学意义（P＜0.05）.两组术后随访RALD、RVDD、RALD/LALD、RVDD/LVDD均有下降,LVDD逐渐增大,封堵器厚度变薄,LVEF改善,与术前比较有显著性差异（P＜0.05）;但A组心脏重构及心功能改善程度大于B组（P＜0.05）.结论 椭圆周长公式可应用于ASD封堵器选择,封堵器大小对患儿心脏重构有影响.

Compare two different methods to select amplatzer septal occluder model at atrial septal defect interventional therapy in children

Objective To explore the foundation of selecting atrial septal defect （ASD） occluder in pediatric evaluate the impact of different sizes of Amplatzer septal occluder geometry change on cardiac remodeling and heart function. Methods Forty-six children with ASD were treated by transcatheter closure with the Amplatzer occluder. The diameter of defects was calculated with the oval circumference formula （group A, 23 cases） and the others by echocardiography （group B, 23 cases）. The lateral diameter of left ventricle（LALD）, the lateral diameter of right ventricle （RALD）, RALD /LALD, the diastolic diameter of right ventricle （RVDD）, the diastolic diameter of left ventricle （LVDD）, RVDD/LVDD, and ejection fraction in left and right ventricle were assessed by transthoracic enchocardiography（Tl＇E） before ASD clo- sure and 1 month, 3 months and 6 months after ASD closure. Measure changes in the thickiness of the occluder. Resuits The mean ASD diameter was （16.56±4.23） mm in group A and （17.22±5.08） mm in group B （P 〉O.05）;the mean diameter of the selected occluder of group A （19.18±5.29） mm ]was significantly smaller than that in group B （22.37±6.16） mm] （P 〈 0.05）. The RALD, RVDD, RALD/LALD, RVDD/LVDD ratio were significantly decreased,while the LALD and LVDD significantly increased in the follow up after ASD closure, and ejection fraction in left ventricule im- proved （P 〈0.05）. Gradually reduced thickness oecluder. But the cardiac remodelling and heart function improvement after ASD closure in group A were better than those in group B （P 〈0.05）. Conclusion The oval circumference formula has application value in calculating the diameter of ASD in children, and the size of Amplatzer septal oceluder device has effect on cardiac remodeling and heart function.