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目的总结双盘封堵器(Amplatzer)关闭年龄小、体重轻患儿的继发孔型房间隔缺损(ASD)的病例。方法1998年8月至2004年5月,165例5岁和18kg以下小年龄组继发孔型ASD病例接受Amplatzer封堵器介入治疗。所有患儿均经临床体检、X线胸片、心电图、经胸超声心动图(TTE)确诊为继发孔型ASD。TTE观察和测量ASD和房间隔(IAS)最大径,测量球囊导管测量ASD最大伸展径,必要时加用食道超声(TEE)测定,筛选后的患儿依此选择封堵器。结果163例成功封堵ASD,成功率98.8%。本组ASD最大径(8～30)mm,平均(18.3±5.1)mm,选择封堵器直径(8～30)mm,平均(18.6±5.0)mm,P>0.05。Qp/Qs=3.3±2.0。147例(89.0%)为单纯单孔ASD病例;6例为多孔ASD,其中3例伴有房间隔瘤样改变,均用一个封堵器成功封堵ASD。另外12例合并其他心内畸形,其中6例合并肺动脉瓣狭窄(PS),6例合并动脉导管未闭(PDA)。右心容量超负荷术后明显改善。本组中大ASD占60.0%(100)例。操作上有一定难度。结论Amplatzer封堵器关闭5岁以下儿童房间隔缺损是可行的,但不主张2岁以下行介入治疗。严格掌握适应证;良好的小儿心血管内外科条件是成功封堵的基本保证。
Objective To summarize the case of Amplatzer closure of secondary secundum atrial septal defect (ASD) in younger and underweight children. Methods From August 1998 to May 2004, 165 cases of ASD with small age of 5 years and under 18kg were treated with Amplatzer occluder. All children were clinically diagnosed, chest X-ray, electrocardiogram, transthoracic echocardiography (TTE) diagnosed as secondary perforation ASD. TTE was used to observe and measure the maximum diameter of ASD and atrial septum (IAS). The maximum extension diameter of ASD was measured by balloon catheter. If necessary, esophageal ultrasound (TEE) was used. After screening, the occluder was selected accordingly. Results 163 cases of successful closure of ASD, the success rate of 98.8%. In this group, the diameter of ASD was (8-30) mm and averaged (18.3 ± 5.1) mm. The diameter of occluder (8-30 mm) was selected and averaged (18.6 ± 5.0) mm, P> 0.05. Qp / Qs = 3.3 ± 2.0.147 cases (89.0%) were simple single-hole ASD cases; 6 cases were porous ASD, of which 3 cases were accompanied by atrial septal tumor-like changes were blocked with an occluder ASD. Another 12 patients with other cardiac malformations, including 6 cases with pulmonary stenosis (PS), 6 cases with patent ductus arteriosus (PDA). Right heart volume overload significantly improved after surgery. The large ASD accounted for 60.0% (100 cases). Operation has a certain degree of difficulty. Conclusion Amplatzer occluder closure of atrial septal defect in children younger than 5 years is feasible, but does not advocate intervention in the following 2 years. Strict control of indications; good cardiovascular and surgical conditions in children is the basic guarantee of successful closure.