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目的 探讨用Amplatzer房间隔缺损封堵器经导管堵闭部分边缘缺乏或不足(<5mm)的房间隔缺损的可行性。方法 1999年7月至2 0 0 1年9月对芝加哥大学儿童医院的2 3例边缘<5mm的房间隔缺损患儿试用Amplatzer封堵器进行堵闭,其中男10例,女13例,平均年龄10 7岁。2 0例经食管超声心动图或心内超声心动图测量的房间隔缺损前缘0～4mm ,2例下缘为2mm ,1例后缘为2mm。同期,4 8例房间隔缺损边缘>5mm的患儿作对照。结果 全部2 3例边缘<5mm的房间隔缺损患儿和4 8例对照儿均成功安装了封堵器。两组间年龄、缺损大小和所用封堵器大小差异无显著性意义(P >0 . 0 5 )。2 3例边缘<5mm的患儿中17例(73. 9% )即刻完全堵闭,对照组4 4例(91 .7% )即刻完全堵闭(P <0 .0 5 ) ;2 4h复查边缘<5mm患儿及对照组的完全堵闭率分别是91 3%和93 8% (P >0. 0 5 ) ;6个月复查两组完全堵闭率分别是95 7%和95 8% (P >0 . 0 5 )。缺损边缘<5mm患儿及对照组手术时间分别为(72 . 5±2 6 .5 )min和(6 1. 4±2 1 .9)min ;X线暴光时间分别为(12 .6±7 .0 )min和(9. 8±4 . 2 )min ,与对照组比较手术时间稍长。两组患儿术中和术后均未出现并发症。结论 前、后或下缘<5mm的房间隔缺损仍可以用Amplatzer房间隔缺损封堵器经导管堵闭,但长期手术
Objective To explore the feasibility of using Amplatzer atrial septal defect occluder to lack or not enough (<5mm) atrial septal defect. Methods From July 1999 to September 2001, 23 children with atrial septal defect whose marginal margin <5mm had been blocked by Amplatzer occluder were enrolled in the Children’s Hospital of University of Chicago, including 10 males and 13 females, with an average of Age 10 7 years old. Twenty (20%) cases of atrial septal defects measured by transesophageal echocardiography or intracardiac echocardiography had a margin of 0-4 mm, a lower margin of 2 mm and a margin of 2 mm. Over the same period, 48 cases of atrial septal defect edge> 5mm in children as a control. Results All 23 cases of atrial septal defect with edge <5mm had successful occluder closure in 48 children. There was no significant difference between the two groups in the age, defect size and occluder size used (P> 0.05). Twenty-three (73.9%) of 23 children with margins of <5mm had complete occlusion immediately, while 4 of the controls (91.7%) immediately stopped completely (P <0.05) The complete occlusion rates of borderline <5mm children and control group were 91.3% and 93.8% respectively (P> 0.05). The complete closure rates of the two groups after 6 months were 95.7% and 95.8% (P> 0.05). The operation time of children with <5mm marginal defect and control group were (72.5 ± 26.5) min and (6.14 ± 21.9) min respectively; the time of X-ray exposure was (12.6 ± 7) .0) min and (9. 8 ± 4. 2) min, respectively. Compared with the control group, the operation time was slightly longer. No complications occurred in both groups during and after operation. Conclusions Atrial septal defects <5mm anterior, posterior, or inferior margin can still be amputated with Amplatzer atrial septal defect occluders, but long-term surgery