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目的探讨成人继发孔型房间隔缺损(ASD)边缘形态学特点及其对封堵术的影响。方法收集本院1997年9月—2005年12月符合封堵治疗适应证的272例40岁以上成人继发孔型ASD,采用Amplatzer法封堵ASD。封堵前均采用经胸超声心动图(TTE)和经食管超声心动图(TEE)对缺损形态学进行全面评价,按照残存边缘条件进行分组。分别对两组的缺损大小、边缘形态和长短、封堵器直径、成功率,残余分流率和并发症等指标进行分析。结果本组全部272例中存在短边者96例,占35.3%;薄边者61例,占22.4%。短边以前缘最常见69例(71.9%),长度(1.4±1.4)mm;薄边以后下缘最常见,占59.0%(36例),长度2～23mm,平均长度(6.7±6.3)mm。A组[短边和(或)薄边]共135例,占49.6%,B组(边缘良好)共137例,占50.4%。A、B两组在性别、年龄方面差异均无统计学意义,两组技术成功率、残余分流和并发症发生率等差异亦无统计学意义。但两组缺损TTE径[(18.9±5.5)mm和(16.5±4.8)mm,P<0.01]、TEE径[(22.7±5.0)mm和(20.0±5.5)mm,P<0.01]、所选用的封堵器直径[(29.1±5.7)mm和(26.0±5.9)mm,P<0.01]以及肺动脉收缩压[(36.9±11.9)mmHg(1mmHg=0.133kPa)和(32.6±9.1)mmHg,P<0.01]差异均有统计学意义,A组均高于B组。A、B两组封堵器直径与TTE和TEE所测量的直径之间均具有较好的相关性(A组TTE:r=0.709,TEE:r=0.850;B组TTE:r=0.716,TEE:r=0.915)。B组均高于A组,而且两组中封堵器直径与TEE值的相关性均高于与TTE的相关性。结论成人继发孔型ASD近一半合并边缘短缺和(或)边缘变薄,但选择直径更大的封堵器仍可以成功实施封堵治疗。而根据TTE和TEE,特别是后者所测量的直径能够准确地选择合适的封堵器。
Objective To investigate the morphological characteristics of adult secundum atrial septal defect (ASD) and its influence on occlusion. Methods A total of 272 ASD secondary to obese adults over 40 years of age from September 1997 to December 2005 were enrolled in this study. Amplatzer method was used to block ASD. Before occlusion, both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were used to evaluate the morphological features of the defects and group them according to the residual edge conditions. The size of the defect, the shape and length of the edge, the diameter of the occluder, the success rate, the residual shunt rate and complications were analyzed respectively. Results There were 96 cases with short sides in all 272 cases in this study, accounting for 35.3%; there were 61 cases with thin edges, accounting for 22.4%. The shortest edge of the most common 69 cases (71.9%), length (1.4 ± 1.4) mm; thin edge after the lower edge of the most common, accounting for 59.0% (36 cases), length 2 ~ 23mm, the average length of 6.7 ± 6.3mm . There were 135 cases (49.6%) in group A [short side and / or thin side], and 137 cases (50.4%) in group B (with good margin). There was no significant difference in gender and age between groups A and B, and there was no significant difference between the two groups in technical success rate, residual shunt and complication rate. However, the TTE diameter [(18.9 ± 5.5) mm and (16.5 ± 4.8) mm, P <0.01] and TEE diameter [(22.7 ± 5.0) mm and (20.0 ± 5.5) mm, P <0.01] (29.1 ± 5.7) mm and (26.0 ± 5.9) mm, P <0.01] and pulmonary systolic pressure (36.9 ± 11.9 mmHg and 1 mmHg = 0.133 kPa and 32.6 ± 9.1 mmHg, P <0.01], the difference was statistically significant, A group were higher than B group. There was a good correlation between diameter of occluder in group A and group B and diameter measured by TTE and TEE (TTE: r = 0.709, TEE: r = 0.850 in group A, TTE: 0.716, TEE : r = 0.915). B group were higher than the A group, and occluder diameter and TEE value of the two groups were higher than the correlation with the TTE. Conclusion Nearly half of adult ASDs have margins and / or thinning margins. However, the larger diameter occluder can be successfully used for closure therapy. According to the TTE and TEE, especially the diameter measured by the latter, a suitable occluder can be accurately selected.