CAJ | 학술논문

目的评价经导管置人国产封堵器治疗继发孔型房间隔缺损(ASD)的有效性和安全性.方法 2002年11月至2012年6月我院在经胸超声心动图监视下经导管置入国产封堵器治疗继发孔型房间隔缺损278例,经胸超声心动图检查评价术后48 ～72 h、随访1～12个月封堵情况与肺动脉压、右心室舒张末期内径变化及并发症发生情况.合并畸形者同期进行介入治疗.结果 278例房间隔缺损患者缺损最大直径为5.5 ～41.0 mm,平均(21.5 ±6.7) mm;植入国产封堵器278个,封堵器直径6.0～48.0 mm,平均(26.3±7.2) mm;包括细腰型4例,带孔封堵器6例,双封堵器12例.其技术成功率95.7％ (266/278),其手术成功率95.3％(265/278).术中心导管监测肺动脑收缩压从封堵前(37.7±8.6) mmHg降至封堵术后即刻(31.5±5.8) mmHg(t=4.403,P＜0.001).严重并发症总发生率约2.5％(7/278),包括封堵器脱载1例,封堵器释放后移位2例,术后封堵器脱落1例,封堵器血栓形成1例,少量心包积液1例,死亡1例.其他并发症总发生率4.0％(11/278),包括一过性下壁导联ST段抬高5例,一过性Ⅲ度房室传导阻滞1例,阵发性心房颤动4例,右股动静脉瘘1例.经胸超声心动图示少量至中量残余分流:术后即刻22例,术后48～72 h 10例,随访1～12个月7例.术前、术后48～72 h,随访1～ 12个月,肺动脉压与右心室舒张末期内径分别为(41.5 ±16.3)、(36.4±11.2)、(29.5±9.3)mmHg与(37.3 ±8.7)、(34.1±6.8)、(30.3 ±7.2) mm,术后肺动脉收缩压显著降低,右心室舒张末期内径明显缩小(F值分别为30.387、28.223,P均＜0.001).随访1～12个月,所有封堵成功患者均未发现新的心律失常、血栓栓塞、溶血、房室瓣功能障碍、封堵器移位和脱落.结论经导管置入国产封堵器治疗继发孔型ASD有效可行,近期疗效安全可靠,严重并发症发生率低,可作为大多数继发孔型ASD首选治疗方法.
목적 평개경도관치인국산봉도기치료계발공형방간격결손(ASD)적유효성화안전성.방법 2002년11월지2012년6월아원재경흉초성심동도감시하경도관치입국산봉도기치료계발공형방간격결손278례,경흉초성심동도검사평개술후48 ～72 h、수방1～12개월봉도정황여폐동맥압、우심실서장말기내경변화급병발증발생정황.합병기형자동기진행개입치료.결과 278례방간격결손환자결손최대직경위5.5 ～41.0 mm,평균(21.5 ±6.7) mm;식입국산봉도기278개,봉도기직경6.0～48.0 mm,평균(26.3±7.2) mm;포괄세요형4례,대공봉도기6례,쌍봉도기12례.기기술성공솔95.7％ (266/278),기수술성공솔95.3％(265/278).술중심도관감측폐동뇌수축압종봉도전(37.7±8.6) mmHg강지봉도술후즉각(31.5±5.8) mmHg(t=4.403,P＜0.001).엄중병발증총발생솔약2.5％(7/278),포괄봉도기탈재1례,봉도기석방후이위2례,술후봉도기탈락1례,봉도기혈전형성1례,소량심포적액1례,사망1례.기타병발증총발생솔4.0％(11/278),포괄일과성하벽도련ST단태고5례,일과성Ⅲ도방실전도조체1례,진발성심방전동4례,우고동정맥루1례.경흉초성심동도시소량지중량잔여분류:술후즉각22례,술후48～72 h 10례,수방1～12개월7례.술전、술후48～72 h,수방1～ 12개월,폐동맥압여우심실서장말기내경분별위(41.5 ±16.3)、(36.4±11.2)、(29.5±9.3)mmHg여(37.3 ±8.7)、(34.1±6.8)、(30.3 ±7.2) mm,술후폐동맥수축압현저강저,우심실서장말기내경명현축소(F치분별위30.387、28.223,P균＜0.001).수방1～12개월,소유봉도성공환자균미발현신적심률실상、혈전전새、용혈、방실판공능장애、봉도기이위화탈락.결론 경도관치입국산봉도기치료계발공형ASD유효가행,근기료효안전가고,엄중병발증발생솔저,가작위대다수계발공형ASD수선치료방법.
Objective To evaluate efficacy and safety of transcatheter closure of secundum atrial septal defects(ASD) by domestic made septal occluder.Methods Two hundred and seventy-eight patients with secundum ASD were selected as our subjects who all underwent transcatheter closure by domestic septal occluder guided by transthoracic echocardiography in Fujian Provincial Hospital form Nov.2002 to Jun.2012.Transthoracic echocardiography was applied to evaluate pulmonary artery pressure,right ventricular end diastolic diameter and complications at time points of 48-72 hours,1-12 months after closure.Patients with other combined malformations during follow-up periods were performed intervention therapy.Results Among 278 patients,the diameters of ASD were ranged from 5.5 to 41.0 mm and the average was (21.5 ± 6.7)mm.Two hundred and seventy-eight occluders were implanted,including 4 small-waist occluders,6 fenestrated occluders and 12 double occluders.The occluder diameters were ranged from 6.0 to 48.0 mm and the average was (26.3 ± 7.2) mm.The success rate regarding of technique was 95.7％ (266/278) and the procedure success rate was 95.3％ (265/278).The pulmonary artery systolic pressure after closure decreased from (37.7 ±8.6) to (31.5 ±5.8) mmHg through cardiac catheterization (t =4.403,P ＜0.05).The incidence of total severe complications was 2.5％ (7/278),including 1 case of occluder detachment,2 cases of oecluder dislodgement,1 case of device embolization to right ventricular inlet,1 case of occluder thrombus formation,1 case of small pericardial effusion,1 case of death.Other complication occurrence rate was 4.0％ (11/278),including 5 cases with transient inferior ST segment elevation,1 case with transient III degree atrioventricular block,4 cases with paroxysmal atrial fibrillation,1case with the right femoral arteriovenous fistula.Patients with small to moderate residual shunts were 22,10,7 respectively at immediate post-operation,48-72 hours and 1-12 months.pulmonary artery pressure and right ventricular end diastolic diameter were ((41.5 ± 16.3),(36.4± 11.2),(29.5 ±9.3) mmHg respectively; (37.3 ± 8.7),(34.1 ±6.8),(30.3 ±7.2) mm respectively) at time points of before operation,48-72 hours,1-12 months after closure.Pulmonary artery systolic pressure decreased significantly after operation,and right ventricular end diastolic diameter were further markedly reduced after closure during the follow-up periods (F =30.387,28.223,P ＜ 0.001).Furthermore,all patients with succeed surgery showed no new arrhythmia,thromboembolism,hemolysis,atrioventricular valve dysfunction,occluder dislodgement and embolization.Conclusion Transcatheter closure of secundum ASD using domestic septal occluder is proved effective,safe and reliable with a low incidence of severe complications in the short term,suggesting it can be a preferred treatment on the most selected secundum atrial septal defect patients with occluded indications.