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目的探讨使用国产封堵器介入治疗巨大房间隔继发孔缺损(atrial septal defect,ASD)的可行性和安全性。方法经胸/经食管彩色多普勒超声心动图证实巨大ASD患者62例,在经胸超声心动图及X线透视监护下,根据ASD边缘不足情况分别制定封堵策略,选用国产封堵器行介入封堵治疗,记录围术期并发症,随访复查7d、6个月、18个月经胸多普勒超声心动图、心电图和胸片和临床事件(心包填塞、心脏破裂、血栓、感染性心内膜炎和死亡)。结果 56例巨大继发孔ASD经导管封堵成功,成功率90.3%。6例患者试封堵失败,根据分型分别为后缘并下腔静脉缘不足型3例,主动脉缘并下腔静脉缘不足型3例。围术期并发症包括封堵器脱落2例、房间隔残缘断裂1例,3例患者均行外科手术、取出封堵器/房间隔补片修补术。一过性ST段抬高和一过性黑矇各1例。术中及随访期间无临床事件发生。结论巨大ASD可以行介入封堵治疗,国产封堵器介入封堵巨大房间隔缺损患者安全、有效、并发症少、费用低,可作为有封堵适应证患者的首选方案。
Objective To investigate the feasibility and safety of using domestic occluder for interventional treatment of giant atrial septal defect (ASD). Methods The transthoracic / transesophageal color Doppler echocardiography was performed in 62 patients with huge ASD. Under transthoracic echocardiography and X-ray fluoroscopy, the occlusion strategy was developed according to the ASD margin. Interventional occlusion therapy was used to record the perioperative complications. The patients were followed up for 7d, 6months and 18months. Transthoracic Doppler echocardiography, electrocardiogram, chest radiography and clinical events (tachycardia, heart rupture, thrombus, Endometritis and death). Results 56 cases of huge secondary orifice ASD succeeded in transcatheter closure with a success rate of 90.3%. Six patients failed to block the test, according to the classification of the posterior margin and inferior vena cava margin insufficiency in 3 cases, aortic margin and inferior vena cava margin in 3 cases. Perioperative complications included occlusion device shedding in 2 cases, atrial septal rupture in 1 case, 3 patients underwent surgery, removal of occluder / atrial septal patch repair. A transient ST-segment elevation and transient amaurone in 1 case. No intraoperative and follow-up clinical events. CONCLUSION: A huge ASD can be involved in the treatment of occlusion. Domestic occluder is safe and effective in the treatment of patients with huge ASD, with few complications and low cost. It can be used as the first choice for patients with occluder indications.