摘要
为探讨Amplatzer房间隔封堵器 (ASO)在儿童中的应用限度 ,并进行方法学评价 ,共有68例符合手术指征的继发孔型ASD患儿接受了经导管ASO封堵术。术中经右上肺静脉造影、经食道超声心动图 (TEE)测量ASD位置、大小及周围关系 ,并以扩张球囊测量ASD伸展直径 ,按此选择等于或大于其1mm～2mm的封堵器 ;对于>25mm伸展直径的ASD或房缺主动脉根部前缘缺如的ASD ,所选ASO应大于其2mm～4mm。房缺前缘近主动脉根部的缺如并不影响装置的成功放置 ,但房缺后上缘是否有足够距离对手术的成功是决定性的。手术操作按常规进行。术后即刻行TEE或TTE检查观察治疗效果 ,此后定期检查评价疗效。结果68例患儿ASD术前TEE直径 (13.26±4.74)mm ,球囊伸展直径 (15.96±5.44)mm ,选用封堵器腰部直径 (10～32)mm,平均 (16.35±5.81)mm。68例均一次手术封堵成功 ,技术成功率100 % ;65例术后即刻TEE/TTE检查示完全封堵无分流 ,完全封堵率95.6% ;3例术后发生无血液动力学意义的少量残余分流 ,残余分流率4.4 % ,2例24小时后TTE复查分流消失 ,1例1年后消失。除2例装置释放后曾出现一过性房性早搏 (2.9 %)外 ,无其它并发症发生。结果表明虽然ASO对堵塞继发孔型房缺安全有效、无并发症、无死亡率、装置结构简单、操作方便、可多次回撤与重新?
The aim of this study was to assess the limitations and methodology of transcatheter closure of atrial septal defects(ASD) in children with the Amplatzer septal occluder(ASO).The authers examined the efficacy and safety of ASO,a new self_centering septal occluder consisting of two round disks made of Nitinol wire mesh and linked together by a short connecting waist.68 children with secundum ASD met with the criteria for transcatheter closure received this operation through the two_dimensional echocardiography and cardiac catheterization.The balloon_stretched diameter of ASD was determined by fluoroscopy,ultrasound and measuring plate.The size of ASO was chosen to be equal to or 1_2 mm more than the stretched diameter.In patients with larger defects over 25 mm in diameter,or in defects without an anterior rim around the aorta,a device with 2 to 4 mm larger than the stretched defect size measured should be used to compensate the reduction of the stent size with increasing distance of both discs in these defects. A missing anterior rim towards the aortic root is no more limiting,but on the other hand,a sufficient posterior rim is decisive for the implantation success.This device was advanced transvenously into a long guiding sheath and deployed under fluoroscopic and ultrasound guidance.Once its position was optimal,it was released.Follow_up studies were kept after 24 hours and 1,3,6 and 12 months,and then yearly.The mean ASD diameter measured with transesophageal echocardiography was 13.26±4.74mm,significantly smaller(P<0.01) than the balloon_stretched diameter of the ASD(15.96±5.44 mm).The diameter of this device was 10_32mm(mean 16.35±5.81mm).The complete occlusion rate was 95.6%.A trivial hemodynamically insignificant residual shunt remained in 3 patients(4.4%),but disappeared at the 24_hour follow_up in 2 patients and at 1 year follow_up in 1 patient.No complication occurred except transient atrial premature beats happened in 2 patients(2.9%).Our results indicate the ASO is an ef_ficient prosthesis,safely used in children with the secundum ASDs.It is simpler in construction,easy to be deployed and can be withdrawn and repositioned for many times.Transesophageal echocardiography can provide useful information with this procedure.Further investigations are still required to expand its indication in children and standardize its methodology.Furthermore,long_term follow_up is needed to exclude possible adverse side effects.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2002年第7期390-392,共3页
Journal of Clinical Pediatrics
