胡海波,蒋世良,徐仲英,张戈军,宋会军,金敬琳,李世国,吕建华,刘琼,徐亮,万俊义

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院介入放射科

摘要(Abstract)：

目的分析总结房间隔缺损封堵术后发生心脏磨蚀的情况,探讨这种严重并发症的发生原因、预防和处理办法。方法回顾性分析1997年9月至2016年9月在阜外医院接受经导管房间隔缺损封堵术的6903例患者,总结术后发生心脏磨蚀病例的基本情况,包括心脏磨蚀发生的时间、类型、处理方法、最终临床转归等情况。结果共有9例患者术后发生心脏磨蚀事件,发生率为0.13%;包括急性心脏压塞2例,主动脉-右心房瘘2例(1例伴溶血),二尖瓣前叶穿孔3例(其中1例伴溶血),少-中量心包积液2例。发生心脏磨蚀事件的时间从术后1天至半年不等。9例发生心脏磨蚀事件的患者中无1例死亡发生,2例急性心脏压塞患者均行急诊心包引流术后好转,1例主动脉-右心房瘘行经导管瘘口封堵术成功,1例主动脉-右心房瘘行外科取伞后房间隔及瘘口修补术成功,1例二尖瓣前叶穿孔伴溶血的患者行外科瓣膜修补术+外科取伞后房间隔修补术成功,其余4例患者均无明显症状,目前仍在随访观察中。结论心脏磨蚀是目前经导管置入镍钛合金材质封堵器治疗房间隔缺损的严重晚发并发症,发生率虽低但危害比较大,部分病例可能与封堵器选择过大和不当有关,也有部分病例原因不甚明了。术后严格随访、及早发现和处理是临床应对的关键。

关键词(KeyWords)： 心脏磨蚀;房间隔缺损封堵术;心脏压塞

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 胡海波,蒋世良,徐仲英,张戈军,宋会军,金敬琳,李世国,吕建华,刘琼,徐亮,万俊义

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