房间隔缺损并发畸形的介入治疗

目的 :评价同期应用介入治疗房间隔缺损 （ASD）及其并发心脏其它畸形的可行性和治疗效果。方法 :全组 7例 ,年龄 2～ 6 5 （34± 2 8）岁。经临床、心电图、X线及超声心动图诊断为 ASD并发其他心脏畸形 ,其中 3例为肺动脉瓣狭窄 ,2例为二尖瓣狭窄 （L utembacher综合征 ） ,2例为动脉导管未闭 （PDA ）。应用 Amplatzer封堵器经导管关闭ASD前 ,先纠正其它畸形 （包括瓣膜成形术及 PDA封堵术 ）。术后 3d,1～ 6月分别行经胸超声心动图 （TTE）、心电图、X线检查评价治疗效果。结果 :7例同期介入治疗均获得成功 ,术中未发生任何重要并发症。术后 3d,1～ 6月TTE显示房间隔无残余分流。并发肺动脉瓣狭窄患者 ,术后即刻跨肺动脉瓣压差得到满意的下降 ;L utembacher综合征患者 ,二尖瓣瓣口面积分别由术前 1.0 ,1.2 cm2增加到术后 1.9,2 .0 cm2 ,左房平均压分别由 2 9,2 6 m m Hg（1mm Hg=0 .133k Pa）降至 8,7m m Hg;并发 PDA患者 ,应用 Amplatzer封堵器 PDA关闭术后 10 min降主动脉侧位造影 ,无残余分流。术后 6月 X线检查显示肺血减少 ,心脏房、室缩小。结论 :同期介入治疗 ASD并发某些心脏畸形是一种有效、安全、简便可行的方法。

Transcatheter closure of complex atrial septal defects

AIM: To evaluate the efficiency and feasibility by transcatheter therapy of complex atrial septal defect(ASD) . METHODS: 7 patients with complex ASD were treated in or during with the same procedure by combined transcatheter techniques(balloon valvuloplasty and patent ductus arteriosus occlusing) before ASD occlusion using Amplatzer occluder device. Three patients had pulmonary stenosis, two had mitral stenosis(Lutembacher syndrome), two had patent ductus arteriosus(PDA). Transthoracic echocardiography(TTE),ECG and X-ray examination were done 3 days and 1 ~6 months after the procedure to evaluate the efficiency. RESULTS:The success rate of transcatheter therapy of complex atrial septal defect was 100%. No complications occurred during the procedure, No residual shunts were found 3 days after the procedure and in 1~6 month follow-up. Satisfactory reduction of pressure gradient across valve and complete obiteration of left to right atrial were achieved for ASD associated with pulmonary stenosis. Mitral valve area increased from 1.0,1.2 to 1.9,2.0 cm 2 ,the mean left atrial pressure decreased from 29,26 mm Hg to 8,7mm Hg for two Lutembacher syndromes respectively. The lateral descending aortographies indicated complete immediate closure of PDA 10 minutes after PDA occluder placement for two ASD patients with PDA. X-ray examination showed that pulmonary vascularity and heart size were improved. CONCLUSION: Transcatheter therapy of complex ASD was an effective, feasible and safe nonsurgical method.