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目的总结微创经胸封堵术治疗继发性ASD的临床效果。方法选择采用微创经胸封堵ASD患儿10例。男3例,女7例;年龄3～14岁;体质量12～35 kg。全身麻醉成功后,经胸骨右缘第4肋间切开进入胸腔,打开并悬吊心包,在右心房壁缝荷包,把输送器置入右心房,在食管心脏超声心动图引导下,将输送器通过ASD送至左心房,先释放左心房侧封堵伞,缓慢推出鞘管,使封堵伞紧贴房间隔,回撤退、送鞘管入右心房,卡紧后,再释放右侧封堵伞。食管心脏超声心动图证实无残余分流,完全释放封堵伞,确认封堵伞位置后,退出导管,荷包线打结,严密止血,依次缝合,结束手术。结果 10例ASD患儿中9例一次性封堵成功,1例因封堵失败转为右侧侧切口开胸体外循环下行ASD修补手术。无一例死亡,无输血病例。术后复查心脏彩超和ECG,无残余分流、封堵器脱位、栓塞、心律失常发生。术后随访3～12个月,患儿均恢复良好。结论微创经胸封堵术治疗继发性ASD恢复快、创伤小、安全性高。
Objective To summarize the clinical effect of minimally invasive transcatheter closure for the treatment of secondary ASD. Methods A total of 10 ASD children with minimally invasive transthoracic closure were selected. 3 males and 7 females; aged 3 to 14 years old; body weight 12 to 35 kg. After the success of general anesthesia, the fourth intercostal space on the right margin of the sternum was cut open into the thoracic cavity, the pericardium was opened and suspended, the purse was placed in the right atrial wall, and the delivery device was put into the right atrium. Under the guidance of esophageal heart echocardiography, Through the ASD sent to the left atrium, the first release of the left atrial occlusion umbrella, the introduction of the sheath slowly, so that the closure of the umbrella close to the atrial septum, back to retreat, send sheath into the right atrium, tight, and then release the right side of the seal Block the umbrella. Esophageal echocardiography confirmed no residual shunt completely release of the blocked umbrella, confirm the location of the blocked umbrella, exit the catheter, purse tie, tight hemostasis, followed by suturing, the end of surgery. Results Nine of 10 children with ASD were successfully treated with one-off occlusion, and one patient underwent ASD with open cardiopulmonary bypass due to failed closure of the right lateral incision. No case of death, no blood transfusion cases. Postoperative review of cardiac ultrasound and ECG, no residual shunt, occluder dislocation, embolism, arrhythmia. All patients were followed up for 3 to 12 months. Conclusion Minimally invasive transcatheter closure of secondary ASD recovery faster, less trauma, high safety.