摘要
目的分析总结房间隔缺损封堵术后发生心脏磨蚀的情况,探讨这种严重并发症的发生原因、预防和处理办法。方法回顾性分析1997年9月至2016年9月在阜外医院接受经导管房间隔缺损封堵术的6903例患者,总结术后发生心脏磨蚀病例的基本情况,包括心脏磨蚀发生的时间、类型、处理方法、最终临床转归等情况。结果共有9例患者术后发生心脏磨蚀事件,发生率为0.13%;包括急性心脏压塞2例,主动脉-右心房瘘2例(1例伴溶血),二尖瓣前叶穿孔3例(其中1例伴溶血),少-中量心包积液2例。发生心脏磨蚀事件的时间从术后1天至半年不等。9例发生心脏磨蚀事件的患者中无1例死亡发生,2例急性心脏压塞患者均行急诊心包引流术后好转,1例主动脉-右心房瘘行经导管瘘口封堵术成功,1例主动脉-右心房瘘行外科取伞后房间隔及瘘口修补术成功,1例二尖瓣前叶穿孔伴溶血的患者行外科瓣膜修补术+外科取伞后房间隔修补术成功,其余4例患者均无明显症状,目前仍在随访观察中。结论心脏磨蚀是目前经导管置入镍钛合金材质封堵器治疗房间隔缺损的严重晚发并发症,发生率虽低但危害比较大,部分病例可能与封堵器选择过大和不当有关,也有部分病例原因不甚明了。术后严格随访、及早发现和处理是临床应对的关键。
Objective To investigate the characteristics, occurrence times and management of cardiac erosion after transcatheter closure of ASD, and to discuss the mechanism and predictive factor of erosion. Methods We analyzed all the cases who received transcatheter ASD closure from September 1997 to September 2016 in our hospital retrospectively. Results 9 cases （9/6903, 0.13%） were reported to have cardiac erosion events after device closure ASD of including 2 cases of acute cardiac tamponade needed pericardiocentesis, 2 cases of aorta-to right-atrial fistula needed transcatheter closure or operative i repair and 5 cases of perforation of the anterior leaflet of mitral valve.1 case with MV anterior leaflet perforation presented with hemolysis and required surgical repair. Cardiac erosion events were found at average 52.9-68.3 days （1-180days） after the ASD closure. Conclusions Cardiac erosion is a rare but serious complication of device closure for ASD. or deficient retro-aortic rims. It is important for when an erosion event is identified, occurring. Erosion events are mostly attributed to device over-sizing a strict follow-up, early deduction and timely disposition
出处
《中国介入心脏病学杂志》
2017年第10期557-560,共4页
Chinese Journal of Interventional Cardiology
