【摘要】 目的:评价应用Amplatzer ASD封堵器介入治疗巨大房间隔缺损(ASD)的疗效。方法:所有患者均在X线透视和经胸超声心动图(TTE)监测下,按照TTE所测的ASD最大伸展直径加4~8mm或者按所选封堵器周径﹥ASD周径的1/8~1/10选择Amplatzer ASD封堵器,操作采用"心房法"。术后随访行TTE、胸X片线及心电图检查,观察Amplatzer ASD封堵器的位置、形状及与相邻瓣膜的关系,了解肺血及心胸比例的情况,以评价其疗效及安全性。结果:63例ASD中,60例封堵成功,成功率为95.2%。术后即刻行TTE检查有6例存在少量残余分流,均于术后72h~3个月内消失;18例合并肺动脉高压患者术后3个月肺动脉压力均有不同程度下降;52例合并三尖瓣关闭不全及16例合并二尖瓣关闭不全患者术后3个月均有不同程度好转;早期有7例患者出现阵发性室上性心律失常,于出院前全部自行消失;术前8例心房颤动者术后有4例转为窦性心律;术前13例患者合并有完全或不完全性右束支传导阻滞,9例消失于术后6个月内,其余4例成为永久性。所有患者X线平片显示:肺血不同程度减轻,心胸比例不同程度缩小。所有成功封堵患者术后封堵器无组织反应、无金属反应,封堵器位置准确稳定,装置无变形及折断,无血栓形成及溶血等严重并发症的发生。结论:应用Amplatzer ASD封堵器封堵巨大ASD是安全的,有效的,但在操作中应注意防止封堵器脱落并发症的发生。更多还原

【Abstract】 Objective: To evaluate the application of Amplatzer ASD occlude interventional therapy Large atrial septal defect. Methods: All patients were in X-ray fluoroscopy and transthoracic echocardiography( TTE) monitoring,according to the measure of the ASD TTE maximum diameter and 4-8mm stretch or according to the occluder circle diameter more than ASD circle diameter of 1 /8-1 /10 to choose occluder,operation using Atrial method. Follow-up TTE,chest X-ray and cardiogram,observe the position and shape of occluder, and observe the relationship of adjacent heart ales,the cardiothoracic ratio and lungs blood,to evaluate its effectiveness and safety. Results: 63 ASD,60 cases success rate,sealing 95. 2%. TTE do check immediately after postoperation,six cases existing a small residual shunt and 72h-3 months to disappear,18 cases of patients with pulmonary arterial hypertension merge after 3 months of pulmonary artery pressure drop in different degree,52 cases of combined tricuspid regurgitation and 16 cases of combined mitral valve insufficency after 3 months different degree was improved,Early has seven patients appeared paroxysmal SAs-supraentricular arrhythmias and all disappear before discharge; Preoperative 8 cases of atrial fibrillation 4 cases to the postoperative sinus rhythm,Preoperative 13 patients with complete or incomplete right bundle branch block,9 cases disappear in 6 months postoperatively,the four cases of permanent. All patients X-ray shows: lung,reduce blood different proportion of different levels. All successful sealing patients,no tissue reaction,no metal reaction,occluder location accuracy,the device without deformation and broken,without thrombosis and hemolysis severe complications. Conclusion: The application of Amplatzer ASD occluder sealing large ASD is safe,effective,but in operation should be paid attention to in the occluder off to prevent the occurrence of complications.更多还原