张蕾,周达新,赵维鹏,潘文志,张晓春,葛均波

• 1:复旦大学附属中山医院心内科
• 2:复旦大学附属中山医院超声心动图室

摘要(Abstract)：

目的评估多发性房间隔缺损(mfASD)经导管封堵治疗中个体化选择封堵器对疗效和并发症的影响。方法回顾性入选2006年7月至2015年7月在复旦大学附属中山医院心内科住院的mfASD患者共76例,收集患者临床及随访数据。结果 76例患者中男性18例,年龄18~75(42.3±14.9)岁。房间隔缺损(ASD)形态学特点为:60例(78.9%)为双孔性ASD;16例(21.1%)为筛孔性ASD,其中有3例(3.9%)为卵圆孔未闭(PFO)合并ASD,13例(17.1%)合并房间隔瘤。73例(96.1%)患者器械封堵成功,其中26例(35.6%)使用双封堵器封堵成功(双封堵器组),47例(64.4%)使用单封堵器封堵成功(单封堵器组)。在单封堵器组中,有7例(14.9%)患者使用测量球囊辅助后封堵成功。单封堵器组使用大小边型封堵器比率高于双封堵器组[11例(23.4%)比3例(11.5%),P=0.352],但差异无统计学意义;单封堵器组患者并发症发生率显著低于双封堵器组(4.3%比19.2%,P=0.037),差异有统计学意义。随访发现两组患者残余分流发生率的差异无统计学意义(P>0.05)。结论经导管封堵治疗mfASD应根据ASD的形态学个体化选择封堵器,对于特定的患者使用双封堵器治疗mfASD是可行、安全和有效的。

关键词(KeyWords)： 多发性房间隔缺损;经导管封堵;双封堵器;超声心动图

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张蕾,周达新,赵维鹏,潘文志,张晓春,葛均波

参考文献(References)：

• [1]King TD,Thompson SL,Steiner C,et al.Secundum atrial septal defect.Nonoperative closure during cardiac catheterization.JAMA,1976,235(23):2506-2509.
• [2]Du ZD,Hijazi ZM,Kleinman CS,et al.Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults:results of a multicenter nonrandomized trial.J Am Coll Cardiol,2002,39(11):1836-1844.
• [3]中国医师协会心血管内科分会先心脏病工作委员会.常见先天性心脏病介入治疗中国专家共识——一、房间隔缺损介入治疗.介入放射学杂志,2011,20(1):3-9.
• [4]Berger F,Vogel M,Alexi-Meskishvili V,et al.Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects.J Thorac Cardiovasc Surg,1999,118(4):674-678.
• [5]Cowley CG,Lloyd TR,Bove EL,et al.Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder.Am J Cardiol,2001,88(5):589-591.
• [6]Thomson JD,Aburawi EH,Watterson KG,et al.Surgical and transcatheter(Amplatzer)closure of atrial septal defects:a prospective comparison of results and cost.Heart,2002,87(5):466-469.
• [7]Mahadevan VS,Gomperts N,Haberer K,et al.Transcatheter closure of atrial septal defects with multiple devices in Adults:proceduraland clinical outcomes.Int J Cardiol,2009,133(3):359-363.
• [8]Bramlet MT,Hoyer MH.Single pediatric center experience with multiple device implantation for complex secundumatrial septal defects.Catheter Cardiovasc Interv,2008,72(4):531-537.
• [9]Kaulitz R,Paul T,Hausdorf G.Extending the limits of transcatheter closure of atrial septal defects with the double umbrella device(Cardio SEAL).Heart,1998,80(1):54-59.
• [10]Hijazi ZM,Bova S,Rhodes J.Simultaneous transcatheter closure of two secundum atrial septal defects using the Amplatzer TM septal occluder.J Interv Cardio,2010,11(3):181-184;
• [11]徐仲英,徐立,戴汝平,等.经导管置入Amplatzer封堵器治疗多孔的房间隔缺损及其初步疗效评价.中国介入心脏病学杂志,2001,9(3):125-127.
• [12]Kuo BT,Whitbeck MG,Gurley JC,et al.Double atrial septal Defect:diagnosis and closure guidance with 3D transesophageal echocardiography.Echocardiography,2011,28(6):E115-E117.
• [13]Kijima Y,Akagi T,Nakagawa K,et al.Three-dimensional echocardiography guided closure of complex multiple atrial septal defects.Echocardiography,2014,31(10):E304-E306.
• [14]Rigatelli G,Dell'Avvocata F,Cardaioli P,et al.Five-year followup of intracardiac echocardiography-assisted transcatheter closure of complex ostium secundum atrial septal defect.Congenit Heart Dis,2012,7(2):103-110.
• [15]Pan M,Suárez de Lezo J,Medina A,et al.Percutaneous treatment of atrial septal aneurysm.Rev Esp Cardiol,2005,58(2):222-226.
• [16]Carano N,Hagler DJ,Agnetti A,et al.Device closure of fenestrated atrial septal defects:use of a single Amplatzer atrial septal occluder after balloon atrial septostomy to create a single defect.Catheter Cardiovasc Interv,2001,52(2):203-207.
• [17]Chun TU,Gruenstein DH,Cripe LH,et al.Blade consolidation of multiple atrial septal defects:a novel approach to transcatheter closure.Pediatr Cardiol,2004,25(6):671-674.
• [18]Boutin C,Musewe NN,Smallhorn JF,et al.Echocardiographic follow-up of atrial septal defect after catheter closure by doubleumbrella device.Circulation,1993,88(2):621-627.
• [19]Song ZY,He GX,Shu MQ,et al.Clinical efficiency and safety analysis of transcatheter closure of multiple atrial septal defects in adults.Clin Cardiol,2009,32(3):130-134.
• [20]Cao Q,Radtke W,Berger F,et al.Transcatheter closure of multiple atrial septal defects.Initial results and value of two-and three-dimensional transoesophageal echocardiography.Eur Heart J,2000,21(11):941-947.
• [21]Berger F,Ewert P,Bj9rnstad PG,et al.Transcatheter closure as standard therapy of most interatrial defects:experience in 200patients treated with the Amplatzer septal occluder.Cardiol Young,1999,9(5):468-473.
• [22]Hu Z,Zhang Y,Zhang T,et al.Comparison of the effectiveness and safety of single versus dual occluders for the closure of multiple atrial septal defects.J Invasive Cardiol,2015,27(6):E90-E97.
• [23]Numan M,El Sisi A,Tofeig M,et al.Cribriform amplatzer device closure of fenestrated atrial septal defects:feasibility and technical aspects.Pediatr Cardiol,2008,29(3):530-535.
• [24]Rastogi N,Smeeton NC,Qureshi SA.Factors related to successful transcatheter closure of atrial septal defects using the Amplatzer septal occluder.Pediatr Cardio1,2009,30(7):888-892.
• [25]王鉴,陈笋,孙锟,等.多孔筛状房间隔封堵器封堵小儿多孔型房间隔缺损.中国介入心脏病学杂志,2014,22(11):685-688.
• [26]赵鹏军,高伟,余志庆,等.多孔型房间隔缺损封堵器封堵小儿多孔型房间隔缺损.介入放射学杂志,2012,21(10):806-809.
• [27]Ewert P,Berger F,Kretschmar O,et al.Feasibility of transcatheter closure of multiple defects within the oval fossa.Cardiol Young,2001,11(3):314-319.