经导管介入治疗婴幼儿继发孔型房间隔缺损110例

目的探讨经导管介入治疗继发孔型房间隔缺损(atrial septal defect,ASD)在婴幼儿中应用的安全性及有效性。方法回顾性分析110例继发孔型ASD婴幼儿患者经导管介入治疗的临床资料,着重分析治疗方法、结果、并发症情况及随访结果。比较治疗前、后主要观察指标的变化,心律失常发生与否与观测指标之间的多因素分析采用偏相关分析。结果患者ASD直径(13.5±4.3)mm,选择ASD封堵器直径(15.9±4.1)mm,全部110例患儿中,有108例成功封堵,总的手术成功率98.2%;封堵术后右心房舒张末期内径和三尖瓣反流面积较术前缩小,差异有统计学意义[(20.1±6.5)mmvs.(22.7±5.8)mm,P0.05;(0.5±0.6)cm2vs.(1.0±0.9)cm2,P0.05];偏相关分析显示,心律失常发生与患儿的体质量(r=0.546,P=0.060)、年龄(r=-0.427,P=0.078)、选择封堵器直径(r=-0.242,P=0.115)之间不存在相关。随访至2009年12月,全部患儿无血栓栓塞、感染性心内膜炎等并发症出现。结论婴幼儿继发孔型ASD经导管介入治疗安全,可靠,并发症少,值得推广应用。

Transcatheter treatment of infantile secundum atrial septal defect in 110 infants

Objectives To evaluate the safety and efficacy on transcatheter closure of secundum atrial septal defect （ASD）in infants and young children. Methods We retrospectively analyzed the clinical data of 110 infants with secundum ASD via catheter intervention in our center, focusing on the therapy method, result, complication and follow- up. We also compared the observation indexes before and after closure, used partial correlation to analyze the relation of arhythmia and observation indexes. Results Diameter of ASD was （13.5±4.3）mm, diameter of ASD occlusion was （15.9±4.1）mm. There were 108 of 110 cases blocked successfully, the success rate was 98.2%. Right atrium end- diastole diameter and area of tricuspid regurgitation significantly deeresaed after operation [ （20.1±6.5）mm vs.（22.7±5.8）mm, P〈0.05 ; （0.5±0.6） cm^2 vs. （ 1.0±0.9） cm^2, P〈0.05 ]. No relationship was found between arhythmia and age （r=0.546, P= 0.060）, weight （r=-0.427,P=0.078）or diameter of ASD occlusion （r=-0.242, P=0.115）. No complications such as thromboembolism and infective endocarditis happened in patients followed up till December 2009. Conclusions Transcatheter closure of secundum atrial septal defects in infant is safe, reliable, and has less complications, which could be widely applied.