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目的探讨经导管介入治疗大孔型房间隔缺损(ASD)的疗效和安全性。方法选择经胸超声心动图确诊的大孔房间隔缺损患者46例,年龄8~71岁,平均37.6岁。术前超声心动图检查ASD最大直经25~38(30±8)mm,术前心功能(NYHA分级)Ⅱ级15例,Ⅲ级5例,其中肺动脉平均压力>25mmHg者28例,封堵前肺动脉压力(32±8.2)mmHg。所有患者均在局麻下,应用X光透视,和经胸心脏超声引导下经导管置入国产封堵器,封堵ASD,对部分ASD残端薄弱者采用“肺静脉法”操作技术完成封堵。结果44例封堵成功,技术成功率95.6%。选择封堵器直经为30~42mm,封堵后肺动脉压降低至(18.4±5.8)mmHg。术中未发生任何重要并发症,无急诊手术病例。失败2例患者ASD伸展径分别为36mm和38mm,缺损后缘缺乏有效房隔组织。术后即刻超声显示6例仍存在微量至少量残余分流,分流束直径小于4mm;术后6月超声心动图检查时无1例残余分流,房间隔封堵器位置稳定。术后6~38个月随访,右心房、右心室缩小,心功能明显改善。无封堵器相关并发症。结论国产封堵器介入治疗大孔房间隔缺损具有操作简便、安全、费用低、技术成功率高及封堵效果好等优点。
Objective To investigate the efficacy and safety of transcatheter interventional treatment of large atrial septal defect (ASD). Methods Forty-six patients with atrial septal defect diagnosed by transthoracic echocardiography were selected, aged from 8 to 71 years, with an average of 37.6 years. Preoperative echocardiography ASD maximum straight through 25 ~ 38 (30 ± 8) mm, preoperative cardiac function (NYHA classification) Ⅱ grade 15 cases, Ⅲ grade 5 cases, of which the average pulmonary artery pressure> 25mmHg in 28 cases, blocking Anterior pulmonary artery pressure (32 ± 8.2) mmHg. All patients under local anesthesia, the application of X-ray, and transcatheter ultrasound-guided transcatheter domestic catheter occlusion, blocking ASD, some of the weak stump ASD using “pulmonary vein method” to complete the blocking operation . Results of 44 cases of successful closure, the technical success rate of 95.6%. Choose occluder straight through 30 ~ 42mm, after the closure of pulmonary artery pressure decreased to (18.4 ± 5.8) mmHg. No major complications during surgery, no emergency surgery cases. Two patients failed to ASD stretch diameter of 36mm and 38mm, the lack of effective posterior margin of the defect atrial septum. Immediate ultrasound showed that there were still 6 cases of residual trace shunt, shunt diameter less than 4mm; 6 months after echocardiography without residual shunt, atrial septal occluder position. After 6 to 38 months of follow-up, right atrium, right ventricle narrowing, cardiac function improved significantly. No occluder-related complications. Conclusion Domestic occluder interventional treatment of atrial septal defect has the advantages of simple, safe, low cost, high technical success rate and good sealing effect.