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目的总结经导管介入治疗≥15mm继发孔型房间隔缺损(ASD)的疗效及安全性。方法1997年9月至2008年6月首都医科大学附属北京安贞医院应用双盘封堵器经导管介入治疗123例≥15mm继发孔型ASD患儿,其中男54例,女69例;年龄2.7～18.0岁,平均(9.11±4.75)岁;体重12～92kg,平均(33.09±17.68)kg。所有患儿均经临床体检、X线胸片、心电图、经胸超声心动图(TTE)确诊为继发孔型ASD。结果118例成功封堵ASD,成功率95.9%。本组病例经TTE测得ASD直径15～34mm,平均(19.35±3.94)mm;选择封堵器直径18～40mm,平均(23.94±4.55)mm。主肺动脉压力(32.73±8.46)(/12.77±4.61)mmHg(1mmHg=0.133kPa),平均压(20.69±5.90)mmHg,Qp/Qs(2.84±2.39):1,全肺阻力(16.56±13.36)kPa·s/L。117例(95.1%)为单孔ASD病例,6例为多孔ASD;1例(两缺损孔之间距离为10mm)分别用14mm和10mm两个封堵器封堵,其余均应用单一封堵器封堵。1例合并预激综合征,1例合并肺动脉瓣狭窄(PS)。结论在严格选择适应证的前提下,经导管介入治疗大型ASD(≥15mm)安全可靠。
Objective To summarize the efficacy and safety of transcatheter interventional therapy of secondary atrial septal defect (ASD) ≥15mm. Methods From September 1997 to June 2008, 123 cases of secondary ASD with ≥15 mm secondary ASD were treated with dual disc occluder by Beijing Anzhen Hospital, Capital Medical University. Among them, 54 were male and 69 were female; age 2.7 ~ 18.0 years old, with an average of (9.11 ± 4.75) years old; body weight 12 ~ 92kg, with an average of (33.09 ± 17.68) kg. All children were clinically diagnosed, chest X-ray, electrocardiogram, transthoracic echocardiography (TTE) diagnosed as secondary perforation ASD. Results 118 cases successfully blocked ASD, the success rate of 95.9%. In this group of patients, the ASD diameter measured by TTE was 15 ~ 34mm (mean, 19.35 ± 3.94mm). The diameter of occluder was 18 ~ 40mm (mean, 23.94 ± 4.55mm). The mean pulmonary artery pressure (32.73 ± 8.46) / (12.77 ± 4.61) mmHg (1mmHg = 0.133kPa), mean pressure (20.69 ± 5.90) mmHg, Qp / Qs (2.84 ± 2.39) kPa · s / L. 117 cases (95.1%) were single-hole ASD cases and 6 cases were porous ASD. One case (the distance between the two defect holes was 10mm) was blocked with two occluders of 14mm and 10mm respectively. Plugged. One case had Wolff-Parkinson-White syndrome and one case had pulmonary valve stenosis (PS). Conclusion In the strict selection of indications under the premise of transcatheter treatment of large ASD (≥ 15mm) safe and reliable.