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目的评价经导管介入封堵术治疗继发孔型房间隔缺损(ASD)的效果与方法学,并探讨ASD患者窦性心律时的肺静脉电位特征。方法本组62例,男25例,女37例,年龄3．5-70 (31．3±15．16)岁。4例应用钮扣装置,余均采用Amplatzer封堵器。其中22例(A组)引用椭圆周长公式计算缺损直径,以此选用封堵器型号,另40例(B组)按超声测量直径选择封堵器。临床、心电图、胸片及超声心动图评价治疗效果。用Lasso电极记录自主及心房起搏状态下肺静脉的电活动规律。结果A组缺损内径为20．18±5．51 mm,B组为21．86±6．18 mm,差异无显著意义(P>0．05);A 组封堵器直径为21．53±5．87 mm,B组为24．19±6．38 mm,两组差异有显著意义(P<0．05);61例封堵术成功,1例失败,成功率98．4％,无任何手术相关并发症发生。3例双孔缺损采用单一封堵器成功封闭。随访3月至7年,ASD完全闭合,无一例残余分流。18例作了肺静脉电位探讨,16例无电位,仅2例存在微小电活动。结论经导管介入治疗ASD成功率及安全性均很高,近远期疗效可靠;椭圆形周长公式在非圆形ASD封堵器选择中具重要应用价值;肺静脉肌袖电位驱动很可能是 ASD并发心房颤动的主要机制。
Objective To evaluate the efficacy and methodology of transcatheter closure of secundum atrial septal defects (ASD) and to investigate the characteristics of pulmonary venous potential during sinus rhythm in patients with ASD. Methods The group of 62 patients, 25 males and 37 females, aged 3.5-70 (31.3 ± 15.16) years of age. 4 cases using button device, the remaining Amplatzer occluder are used. Among them, 22 cases (group A) used the ellipse circumference formula to calculate the diameter of the defect, so the occluder type was selected, and the other 40 cases (group B) were selected according to the diameter of ultrasonic occluder. Clinical, electrocardiogram, chest X-ray and echocardiography to evaluate the therapeutic effect. The electrical activity of pulmonary veins under autonomic and atrial pacing was recorded with Lasso electrodes. Results The diameter of defect in group A was 20.18 ± 5.51 mm and in group B was 21.86 ± 6.18 mm, the difference was not significant (P> 0.05). The diameter of occluder in group A was 21.53 ± 5.87 mm in group B, and 24.19 ± 6.38 mm in group B, with significant difference between the two groups (P <0.05). The successful occlusion was performed in 61 cases, failed in 1 case and the success rate was 98.4% Any surgery-related complications occur. Three cases of double-hole defect using a single occluder successfully closed. Followed up for 3 months to 7 years, ASD completely closed, no residual shunt. Eighteen patients underwent pulmonary venous potentials, 16 patients had no electrical potentials, and only 2 patients had slight electrical activity. Conclusion The success rate and safety of transcatheter interventional therapy for ASD are high, and the curative effect in short-term and long-term is reliable. The ellipse perimeter formula is of great value in the selection of non-circular ASD occluder. The pulmonary sleeve sleeve potential drive is probably ASD The main mechanism of concurrent atrial fibrillation.