论文部分内容阅读
目的评价成年巨大继发孔型房间隔缺损(ASD)介入封堵治疗的可行性、有效性和安全性。方法在经胸超声心动图(TTE)监视下经导管置入国产封堵器治疗成年巨大继发孔型ASD 47例,TTE检查评价术后48~72h、随访1~12个月封堵情况、肺动脉收缩压(SPAP)、右心室舒张末期内径(RVDD)变化及并发症发生情况。结果 47例ASD患者缺损为(33.6±2.7)mm,植入国产封堵器46个,除1个封堵器直径为10mm外,其他封堵器直径为34~48mm。心导管检测术中SPAP从(50.2±10.8)mm Hg降至术后(41.1±9.3)mm Hg(P<0.05)。其手术成功率为93.6%(44/47),并发症发生率为12.8%(6/47)。TTE示术后即刻、术后48~72h、随访(6.0±2.3)个月时存在少至中量残余分流分别为7例(15.6%)、5例(11.4%)、4例(9.3%)。与术前比较,术后SPAP降低,RVDD缩小。随访(6.0±2.3)月,所有封堵成功患者均未发现新的心律失常、血栓栓塞、房室瓣功能障碍、封堵器移位和脱落。结论合理选择适应证,熟练掌握操作技巧,成年巨大继发孔型房间隔缺损介入封堵治疗是安全可行、有效,并发症低,近期疗效满意。
Objective To evaluate the feasibility, effectiveness and safety of adult giant secondary atrial septal defect (ASD). Methods Forty-seven cases of adult giant secondary orifice ASD underwent transcatheter catheterization under transthoracic echocardiography (TTE). TTE was used to assess the occlusion status at 48-72 hours after operation and 1-12 months follow-up. Pulmonary artery systolic pressure (SPAP), right ventricular end-diastolic diameter (RVDD) changes and the incidence of complications. Results A total of 47 ASD patients had a defect of (33.6 ± 2.7) mm and a total of 46 homemade occluders were implanted. The diameter of other occluders was 34-48 mm except for one occluder with a diameter of 10 mm. SPAP decreased from (50.2 ± 10.8) mm Hg to (41.1 ± 9.3) mm Hg after cardiac catheterization (P <0.05). The surgical success rate was 93.6% (44/47), the complication rate was 12.8% (6/47). There were 7 cases (15.6%), 5 cases (11.4%) and 4 cases (9.3%) of TTE after operation, between 48 and 72 hours after operation and 6.0 ± 2.3 months after operation, respectively . Compared with preoperative, postoperative SPAP decreased RVDD reduced. All follow-up (6.0 ± 2.3) months, no new arrhythmia, thromboembolism, atrioventricular valve dysfunction, occluder displacement and shedding were found in all patients with successful occlusion. Conclusion Reasonable selection indications, proficiency in operating skills, adult huge secondary atrial septal defect interventional treatment is safe and feasible, effective, low complication, the recent satisfactory results.