摘要
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 study the clinical technology of transcatheter closure of secundum atrial septal defects (ASD) with Amplatzer device in younger and lower body weight children.Methods The transcatheter closure of ASD using Amplatzer septal occluder (ASO) was performed in 165 children under 5 years of age (75 boys and 90 girls) with secundum ASD from Aug 1998 to May 2004. The age of the cases ranged from 2 to 5 (mean 3.7±1.1) years. The body weight ranged from 9 to 18 (mean 12.6±2.3) kg. The ratio of pulmonary circulation quantity to the systemic circulation quantity (Qp/Qs ) was 3.2±1.9. All the patients underwent clinical examination, X-ray, electrocardiography (ECG) and echocardiography (Echo) for diagnosis of secundum ASD. The transthoracic echocardiography (TTE) was used to detect and measure the defect of the patients and even trans-esophageal echocardiography (TEE) had to be used when it was necessary. With Echo and X-ray guidance, the measuring balloon was used in the body and outside the body to determine the balloon-stretch diameters of ASD, and proper occluders were selected accordingly for the patients for interventional treatment of ASD. Results The devices were implanted successfully in 163 (98.8%) cases. One failure occurred in a case in whom the device moved into the left atrium after release, and the other failure was that the position of the device was uncertain because of temporary unavailability of a special transducer for TEE. Surgical operations were performed for these two cases. The stretch diameter of ASD was from (8-30) mm, (mean 18.3±5.1) mm. The size of device was selected according to the stretch diameter of ASD. The diameter of the occluders selected was from ( 8-30), (mean 18.6±5) mm in this series. The occlusion procedure was monitored by fluoroscopy and TTE and in 5 cases (3%) by TEE. The diameter of right ventricle was improved within 2 days after occlusion from (mean 16.4±4.9) mm to (mean 12.6±3.8) mm,(p<0.01). One hundred and forty seven cases belonged to the simple secundum ASD(89%). Thirteen cases who were complicated with other cardiac deformity were treated successfully with different interventional procedure. Six cases had multiple openings and three of these cases had tumour-like changes of the atrial septum which were closed completely just by one occluder. In only one case small quantity of residual shunt remains. No other severe complication was found in this group. About 100 cases (60%) had large ASD,so the procedure was more difficult in those cases.Conclusion The clinical effectiveness of treatment of ASD in children under 5 years of age with Amplatzer occluders was satisfactory and therefore this therapeutic procedure is feasible for this age group of patients. Nevertheless, we do not recommend to use the technique for infants and children under 2 years of age. Strict selection of indications and proper size of occluder and good cardiologic and surgical settings are among the basic factors for successful interventional occlusion of ASD in young children.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2005年第5期373-376,共4页
Chinese Journal of Pediatrics
