摘要
目的 讨论Cardio Seal和Amplatzer两种封堵器经导管治疗房间隔缺损的应用并对其疗效进行评价。方法 2 4例患者 ,年龄 9～ 49(2 9 33± 14 14)岁 ,体重 42～ 78(5 6 32± 11 49)kg,肺循环与体循环血流量比率 (QP/QS) 1 2 5～ 5 86 (2 78± 1 2 3)。在透视和食管超声引导下 ,经皮穿刺股静脉置入Cardio Seal和Amplatzer封堵器关闭房间隔缺损。术后 2 4小时、3月、6月和 1年行经胸超声心动图、心电图、X线平片检查 ,评价其疗效及并发症。结果 全组技术成功率 10 0 %。术后即刻QP/QS1 0 0～ 1 2 5 (1 0 9± 0 0 8)。Cardio Seal法 6例术后 2 4小时超声心动图显示 ,仅 3例有极少量残余分流 ,1年后该分流消失。有 1例为 2个孔 ,分别置入 2 3mm、2 8mm 2个Cardio Seal封堵器。有 1例于术后 6月心脏超声发现 1条弹性臂断裂但未造成任何影响 ,仍在随访。Amplatzer法 18例 ,其中 2例分别有 3和 2个孔 ,置入直径 30mm和 2 2mm的Amplatzer封堵器各 1个 ;该 18例术后即刻均完全堵闭 ,无残余分流。随访均无再通或装置移位。结论 经导管介入封堵房间隔缺损操作简便、成功率高、疗效可靠。但Amplatzer方法适用范围更广 ,术后即刻成功率更高 ,操作更简便。二者远期疗效尚需进一步观察。
Objective To evaluate the therapeutic effect of transcatheter closure of secundum atrial septal defect (ASD) using Cardio Seal and Amplatzer occluder. Methods Twenty four patients of mean age 29 33±14 14 (ranged from 9-49) years and body weight 56 32±11 49 (ranged from 42-78) kg were studied. The mean pulmonary systemic blood flow ratio (QP∶QS) was 2 78±1 23 (1 25-5 86). The ASD was occluded using Cardio Seal or Amplatzer device through percutaneous procedure under fluoroscopy and transesophageal echocardiography. The transthoracic echocardiography, ECG, and chest film were performed 24 hours, 3 months, 6 months and 1 year after the procedure to evaluate its therapeutic effect and to find the complications. Results The success rate was 100%, QP∶QS was 1 09±0 08 (1 00-1 25) after the procedure. The Cardio Seal devices were used in 6 cases. A very little residual shunt was found in each of 3 cases 24 hours after the procedure, but it was disappeared 1 year later. Two Cardio Seal devices of 23 and 28 mm in diameter were used in one patient with two defects. One arm ruptured at 6 months′ follow up in 1 case without any apparent influence but was still in follow up. The defects were completely and instantly occluded after using Amplatzer occluder in 18 cases, two of them were found with 3 and 2 defects which closed with an Amplatzer occluder of 30 and 22 mm in diameter, respectively. No residual shunt or devices displacement or recanalization was found in the follow up. Conclusions Transcatheter closure of ASD is a simple and convenient method of high success rate and reliable curative effect. The indication of Amplatzer method is much wider and the instant success rate after the procedure is much higher than those of Cardio Seal device. The remote effect of both methods needs further observation.
出处
《中华心血管病杂志》
CSCD
北大核心
2000年第2期93-95,共3页
Chinese Journal of Cardiology
