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1、http:/ - 1 -继发孔型房间隔缺损介入治疗效果及并发症观察继发孔型房间隔缺损介入治疗效果及并发症观察1 饶莉，张立，张庆，贺勇，梁玉佳，曾智 四川大学华西医院 心内科（成都 610041） E-mail： 摘摘 要：要： 目的目的 评价封堵器治疗不同直径继发孔型房间隔缺损（ASD）的效果，分析并发症产生的原因。 方法方法 113 例患者接受封堵治疗，平均年龄(27.5+15.6)岁，术中超声实时引导和监测封堵伞闭合 ASD 的全过程，术后 5 天、3、6 月，1 年及 2 年均行超声心动图检查。 结果结果 109 例 （96.5%） 患者成功置入封堵器， 术前超声测 ASD 直径为 7
2、34 （平均 17.8） mm，术中置入封堵伞平均直径为 24（1238）mm，其中置入封堵伞直径30mm 的患者为 22 例。 105 例（96.3%）显示即刻封堵完全，4 例（3.7%）存在微少量残余分流。术后并发症包括无 Q 波心肌梗死 1 例、残余分流 4 例，封堵伞移位 1 例，绝大多数出现在置入大封堵伞患者。其余患者随访平均 2.5 年未见封堵器移位及残余分流，但置入大封堵伞患者胸闷不适、早搏现象较多见。结论结论 经导管置入封堵器关闭继发孔型 ASD 是一种有效的非外科手术方法，操作简便、创伤小、成功率高。但大直径封堵器出现移位、残余分流及胸部不适症状几率相对较高。 关键词：关键词
3、：房间隔缺损 介入治疗 并发症 继发孔型房间隔缺损（ASD）的介入治疗已开展 10 余年，它克服了外科手术创伤大、留疤痕、术后恢复较慢等缺点，已为广大患者所接受，到目前为止全国已有上千例房间隔缺损患者接受了封堵手术。从国内外文献报道看，该种方法治疗效果较好，但有关并发症报道较少。我们于 1998 年 8 月至 2004 年 6 月，采用封堵器治疗继发孔型ASD 患者 113 例并进行了随访观察，现报告如下。 1资料和方法继发孔型房间隔缺损（ASD）的介入治疗已开展 10 余年，它克服了外科手术创伤大、留疤痕、术后恢复较慢等缺点，已为广大患者所接受，到目前为止全国已有上千例房间隔缺损患者接受了封
4、堵手术。从国内外文献报道看，该种方法治疗效果较好，但有关并发症报道较少。我们于 1998 年 8 月至 2004 年 6 月，采用封堵器治疗继发孔型ASD 患者 113 例并进行了随访观察，现报告如下。 1资料和方法 经临床、心电图、心脏 X 线平片及超声心动图确诊为继发孔型房间隔缺损患者 113 例，男 36 例，女 77 例，年龄 2.567 岁，平均（27.5+15.6）岁。术前年龄16 岁患者均进行经食道超声心动图（TEE）检查，or= 25 mm) atrial septal defects using the Amplatzer septal occluder. Catheter
5、Cardiovasc Interv, 2003; 59(4):522 8 Bialkowski J, Kusa J, Szkutnik M, et al. Percutaneous catheter closure of atrial septal defect. Short-term and mid-term results Rev Esp Cardiol, 2003; 56(4):383 http:/ - 5 -The effect and complications of transcatheter closure of secundum atrial septal defects Ti
6、tle Rao Li, Zhang Li, Zhang Qing, He Yong, Liang Yu-jia, Zeng Zhi. Department of Cardiology, Huaxi Hospital of Sichuan University. 610041 Chengdu, Sichuan. Abstract Objective To observe the effect and complications of transcatheter closure of secundum atrial septal defects(ASD) with different diamet
7、ers using occluder device. Methods Under transthoracic echocardiography (TTE) and digital subtraction angiocardiography monitoring and guidance in the operation, 113 patients (77 female, 36 male) at an average age of 27.515.6y (range 2.567y) with ASD underwent an attempt at transcatheter closure of
8、the defects. TTE were performed 5days, 3 months, 6 months, 1 year and 2 years after the procedure. Results The devices were placed correctly in 109 patients (96.5%). The average diameter of the defects measured by TTE before the procedure was 17.8mm (range 734mm). The average device diameter was 24m
9、m (range 1238mm), and 22 patients were implanted larger occluder (30mm). Among them, the defects were completely closed immediately after the procedure in 105 cases (96.3%) , mild residual shunt were observed in 4 cases (3.7%) and disappeared in 2 cases during 3-month follow-up. The complications si
10、nd inclusive non-Q-wave myocardial infarction, residual shunt and occluder dislocated. They appear all in the patients with larger occluder. In all the other patients, there was no dislocation of the occluder or residual shunt during an average 2.5 year follow-up. Premature beat and discomfort of th
11、e chest were usually observed in patients with larger occluder, during follow-up. Conclusion Transcatheter closure of secundum atrial septal defects was an efficient nonsurgical method with high successful rate, simple procedure and less trauma. But in patients with large occluder, the rate of dislocation of the occluder, residual shunt and discomfort of the chest were higher. Keywords: artrial septum defect, intervention therapy, complicationIn this paper
