论文部分内容阅读
目的:报道使用国产封堵器介入治疗边缘不足(0～4 mm且无有效支撑),巨大36～42 mm房间隔继发孔缺损(ASD)的可行性和体会。方法:经胸和经食管彩色多普勒超声心动图证实36～42 mm巨大ASD,同时证实ASD边缘至少有一边为0～4 mm且无有效支撑的患者36例,按指南方法在经胸和(或)经食管彩色多普勒超声心动图及X线透视监护下行介入封堵治疗;并根据ASD边缘不足情况分房顶缘不足型、二尖瓣缘不足型、主动脉缘不足型、后缘(主动脉对侧缘)不足型、下腔静脉缘不足型及复合不足型,分别制定封堵策略,选择封堵器和封堵方式。结果:①36例继发孔ASD患者缺损36 mm18例、37 mm8例、38 mm4例、39 mm3例、40mm1例、41 mm1例、42 mm1例;②单纯房顶缘不足型4例,单纯二尖瓣缘不足型3例,单纯主动脉缘不足型15例,单纯后缘不足型5例,单纯下腔静脉缘不足型4例,主动脉缘并下腔静脉缘不足型2例,后缘并下腔静脉缘不足型3例;③36例成功封堵32例,成功率达88.89%,不成功4例,缺损分别为36 mm、37 mm、39 mm、41mm各1例,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1例;无介入并发症发生;④封堵器大小为38 mm26例,40 mm6例,均为国产封堵器。结论:边缘不足巨大36～42 mmASD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 report the feasibility and experience of using homemade occluder for the treatment of ASD with marginal margin (0-4 mm and no effective support) and huge 36-42 mm atrial septal defect. Methods: Thoracic and transesophageal color Doppler echocardiography was used to confirm the huge ASD of 36-42 mm. At the same time, it was confirmed that there were 36 patients with at least one side of 0-4 mm in ASD margin and no effective support. According to the guideline method, (Or) transesophageal color Doppler echocardiography and X-ray fluoroscopy interventional intervention; and according to ASD margin insufficiency top hypopnea, mitral insufficiency, aortic insufficiency, after Edge (aortic contralateral margin) insufficiency, inferior vena cava margin insufficiency and composite insufficiency, respectively, to develop a blocking strategy, select the occluder and blocking mode. Results: ①There were 36 cases of 36 cases with ASD in 36 cases, 38 cases of 37 cases in 8 cases, 4 cases of 38 mm in size, 3 cases of 39 mm in size, 1 case of 40 mm in size, 1 case in 41 mm and 42 mm in 1 case. There were 3 cases with insufficient valve margin, 15 cases with insufficient aortic insufficiency, 5 cases with insufficient trailing edge only, 4 cases with insufficient inferior vena cava margin, 2 cases with aortic and inferior vena cava margin, The inferior vena cava marginal insufficiency in 3 cases; ③36 cases successfully blocked in 32 cases, the success rate was 88.89%, 4 cases were unsuccessful, the defects were 36 mm, 37 mm, 39 mm, 41mm, respectively, according to the type were There were 3 cases with posterior margin and inferior vena cava margins, 1 case with aortic border and inferior vena cava margins, and no interventional complications. The occluder size was 38 mm in 26 cases and 40 mm in 6 cases, Device. CONCLUSIONS: An ASD with a marginal margin of 36 to 42 mm may be involved in the treatment of occlusion. A homemade occluder is safe and effective in the treatment of patients with giant atrial septal defect, with few complications and low cost. It can be used as the first choice for patients with occlusive indications .