国产封堵器治疗房间隔缺损的疗效评价
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摘要
目的:评价国产封堵器治疗房间隔缺损(ASD)的疗效。方法:2000～2005年在我科使用国产封堵器治疗的ASD患者357例。术前及术后1周内、6个月、1、2、3年及以上行心电图、经胸超声心动图(TTE)等检查。结果:①手术成功率97.5%。并发症主要发生在术后早期,长期随访未见明显并发症。②ASD封堵术后右心容量负荷明显减少,左室容积及内径增大、左室收缩功能增强;长期随访右房、右室容积缩小,左室舒张末期前后径(LVDd),左室每搏量(LVSV)较术前明显增大,心脏形态与功能进一步改善。③其中38例多孔型房缺及复合畸形患者除1例双孔型ASD患者外手术皆成功(成功率97.4%)。结论:使用国产封堵器治疗继发孔型房间隔缺损适应范围广,成功率高,并发症少,安全可靠。
Objective: To evaluate the efficiency of transcatheter closure of arial septal defect (ASD) with domestic-made occluder device. Methods: There were 357 patients with ASD accepted interventional therapy with domestic-made occluder devices between 2000 and 2005 in our department. They were assessed with electrocardiogram (ECG) and transtho-racic echocardiography (TTE) before the procedure and at follow-up of 1 week, six month, 1 year, 2 year, 3 year and more longer. Results: ① The success rate of the procedure was 97.5%. The complications mainly occurred in the early stage. During the follow-up, no serious complication was found. ②After transcatheter closure, the preload of right heart significantly decreased, while the volume and diameter of left ventricle increased and left ventricular systolic function improved . During the long-term follow-up, the volume of right atrium and right ventricle was decreased, left ventricular end-diastolic diameter (LVDd) and left ventricular stroke volume (LVSV) continued to increase. The cardiac morphology and function improved further. ③ Thirty-eight patients were associated with multifenestrated ASDs or complex malformations. Except one patient with two ASDs, all patients completed the procedure with a successful rate of 97.4%. Conclusion: The use of domestic-made occlucder device in the treatment of ASDs has a wide application range, high success rate and safe and reliable effect as well without significant complications.
Objective: To evaluate the efficiency of transcatheter closure of arial septal defect (ASD) with domestic-made occluder device. Methods: There were 357 patients with ASD accepted interventional therapy with domestic-made occluder devices between 2000 and 2005 in our department. They were assessed with electrocardiogram (ECG) and transtho-racic echocardiography (TTE) before the procedure and at follow-up of 1 week, six month, 1 year, 2 year, 3 year and more longer. Results: ① The success rate of the procedure was 97.5%. The complications mainly occurred in the early stage. During the follow-up, no serious complication was found. ②After transcatheter closure, the preload of right heart significantly decreased, while the volume and diameter of left ventricle increased and left ventricular systolic function improved . During the long-term follow-up, the volume of right atrium and right ventricle was decreased, left ventricular end-diastolic diameter (LVDd) and left ventricular stroke volume (LVSV) continued to increase. The cardiac morphology and function improved further. ③ Thirty-eight patients were associated with multifenestrated ASDs or complex malformations. Except one patient with two ASDs, all patients completed the procedure with a successful rate of 97.4%. Conclusion: The use of domestic-made occlucder device in the treatment of ASDs has a wide application range, high success rate and safe and reliable effect as well without significant complications.
引文
1. King TD,Mills NL.Secundum atrial septal defect:nonoperative closure during cardiac catheterization .JAMA, 1976,235 (23):2506-2509.
2. Rashkind WJ.Transcatheter treatment of congenital heart disease. Circulation, 1983, 67(4):711-716.
3. Lock JE,Rome JJ,Daxis R,et al.Transcatheter closure of atrial septal defect:experimental studies. Circulation, 1989,79(5): 1091 - 1099.
4. Sideris EB,Sideris SE,Thanpoulos BD,et al.Transvenous atrial septal defect occlusion by the buttoned device.Am J Cardiol,1990,66(20):1524-1526.
5. Zahn EM,Benson LN,Hellenbrand WE,et al.Transcatheter closure of secundum ASDs with the CardioSeal septal occluding system:early results of the North American Trial.Ciruculation, 1997,96(supple Ⅱ ):568.
6. Masura J,Gavora P,Formanek A, et al.Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder:initial human experience.Cathet Cardiovasc Diagn,1997,42(5):388-393.
7. Wilkinson JL, Goh TH.Early clinical experience with use of the 'Amplatzer septal oc- cluder' device for atrial septal defect.Caridol Young, 1998,8(3):295-302.
8. Fischer G,Stieh J,Uebing A,et al.Experience with transcatheter closure of secundum atrial septal defect using the Amplatzer septal defect occluder:a single center study in 236 consecutive patients.Heart, 2003,89(2):199-204.
9. Wang JK,Tsai SK, Wu MH,et al.Short-and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer septal occluder.Am Heart J,2004,148(3):511-517.
10. Boutin C, Musewe NN, Smallhorn JF,et al. Ecohcardiograpic follow-up of atrial septal defect after catheter closure by double-umbrella device. Circulation,1993,88(2): 621-627.
11. Vitiello R,McCrindle BW,Nykanem D,et al.Complications associated with pediatric cardiac catheterization.J Am Coll Cardiol ,1998,32(5):1433-1440.
12. Yew G,Wilson NJ,et al.Transcatheter atrial septal defect closure with the Amplatzer septal occluder:five-year follow-up.Catheter Cardiovasc Interv,2005,64(2):193-196.
13. Jan SL, Hwang B,Lee PC,et al.Intracardiac ultrasound assessment of atrial septal defect:comparison with transthoracic echocardiographic,angiocardiographic,and balloon-sizing measurements.Cardiovasc Intervent Radiol,2001,24(2):84-89.
14. Rao PS,Langhough R,Beekman RH,et al.Echocardiographic estimation of balloon-stretched diameter of secundum atrial septal defect for transcatheter occlusion.Am Heart J,1992,124(1):172-175.
15.戴汝平,刘延玲,张戈军,等.应用Amplatzer封堵器介入治疗房间隔缺损疗效评价(附60例报告).中华心血管病杂志,2000,28(2):87-92.
16. Varma C,Benson LN, Silversides C,et al.Outcomes and alternative techniques for device closure of the large secundum atrial defect.Catheter Cardiovasc Inter, 2004,61(1):131-139.
17. Losay J,Petit J, Lambert V,et al.Percutaneous closure with Amplatzer device is a safe and efficient alternative to surgery in adults with large atrial septal defects.Am Heart J, 2001,142(3):544-548.
18. Durongpisitkul K, Tang NL, Soongswang J,et al.Predictors of sucessful transcatheter closure of atrial septal defect by cardiac magnetic resonance imaging.Pediatr Cardiol, 2004,25 (2): 124-130.
19. Landzberg MJ.Closure of atrial septal defects in adult patients:justification of the"tipping point"[J]. J Interven Cardiol,2001,14(2):267- 269.
20. John Sutton,Tajik AJ,McGoon DC,et al.Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up. Circula- tion,1981,64(2):402-409.
21. Chessa M,Carminati M,Butera G,et al.Early and late complications associated with transcatheter occlusion of secundum atrial septal defect.J Am Coll Cardiol ,2002,39(6): 1061-1065.
22. Preventza O, Sampath-Kumar S,Wasnick J,et al.Late cardiac perforation following transcatheter atrial septal defect closure.Ann Thorac Surg,2004,77(4): 1435-1437.
23. Chun DS,Turrentine MW,Moustapha A,et al.Development of aorta-to-right atrial fistula following closure of secundum atrial septal defect using Amplatzer septal occluder. Catheter Cardiovasc Interv,2003,58(2):246-251.
24. Verma PK,Thingnam SK,Sharma A,et al.Delayed embolization of Amplatzer septal occluder device: an unknown entity—a case report.Angiology,2003,54(l): 115-118.
25. Sharafuddin MJ,Gu X,Titus JL,et al.Trans venous closure of secumdum atrial septal defects: preliminary results with a new self-expanding nitinol prothesis in a swine model. Circulation,1997,95(8):2162-2168.
26. Hill SL,Berul CI,Patel HT,et al.Early ECG abnormalities associated with transcatheter closure of atrial septal defects using the Amplatzer septal occluder.J Inerv Card Electro-physiol,2000,4(3):469-474.
27. Ewert P,Berger F,Nagdyman N,et al.Masked left ventricular restriction in elderly patients with atrial septal defects: a contraindication for closure?Catheter Cardiovasc Interv,2001,52(2): 177-180
28. Krumsdorf U,Ostermayer S,Billinger K,et al.Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patientsJ Am Coll Cardiol,2004,43(2):302-309.
29. Anzai H,Child J,Natterson B,et al.Incidence of thrombus formation on the CardioSEAL and the Amplatzer interatrial closure devices.Am J Cardiol,2004,93(4):426-431.
30. Du ZD,Hijazi ZM,Kleinman CS,et al.Comparison between transcatheter and surgical closure of secundum afrial defect in children and adults: results of a multicenter nonran-
domized trial.J Am Coll Cardiol,2002,39(11):1836-1844.
31. Bourdages M,et al.Incidence of headaches after ASD percutaneous catheter closure with Amplatzer device.Canadian Cardiovascular Congress,2002,Edmonton,Alberta.
32. Rodes-Cabau J,Molina C,Serrano-Munuera,et al.Migraine with aura related to the percutaneous closure of an atrial septal defect.Catheter Cardiovasc Interv,2003,60(4):540-542.
33. Wilmshurst PT,Nightingale S,WaIsh KP,et al.Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons. Lancet,2000,356(9294): 1648-1651.
34. Amin Z, Hijazi ZM.Bass JL,et al.Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects :reviwe of registry of complications and recommendations to minimize future risk.Catheter Cardiovasc Interv,2004,63(4):496-502.
2. Rashkind WJ.Transcatheter treatment of congenital heart disease. Circulation, 1983, 67(4):711-716.
3. Lock JE,Rome JJ,Daxis R,et al.Transcatheter closure of atrial septal defect:experimental studies. Circulation, 1989,79(5): 1091 - 1099.
4. Sideris EB,Sideris SE,Thanpoulos BD,et al.Transvenous atrial septal defect occlusion by the buttoned device.Am J Cardiol,1990,66(20):1524-1526.
5. Zahn EM,Benson LN,Hellenbrand WE,et al.Transcatheter closure of secundum ASDs with the CardioSeal septal occluding system:early results of the North American Trial.Ciruculation, 1997,96(supple Ⅱ ):568.
6. Masura J,Gavora P,Formanek A, et al.Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder:initial human experience.Cathet Cardiovasc Diagn,1997,42(5):388-393.
7. Wilkinson JL, Goh TH.Early clinical experience with use of the 'Amplatzer septal oc- cluder' device for atrial septal defect.Caridol Young, 1998,8(3):295-302.
8. Fischer G,Stieh J,Uebing A,et al.Experience with transcatheter closure of secundum atrial septal defect using the Amplatzer septal defect occluder:a single center study in 236 consecutive patients.Heart, 2003,89(2):199-204.
9. Wang JK,Tsai SK, Wu MH,et al.Short-and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer septal occluder.Am Heart J,2004,148(3):511-517.
10. Boutin C, Musewe NN, Smallhorn JF,et al. Ecohcardiograpic follow-up of atrial septal defect after catheter closure by double-umbrella device. Circulation,1993,88(2): 621-627.
11. Vitiello R,McCrindle BW,Nykanem D,et al.Complications associated with pediatric cardiac catheterization.J Am Coll Cardiol ,1998,32(5):1433-1440.
12. Yew G,Wilson NJ,et al.Transcatheter atrial septal defect closure with the Amplatzer septal occluder:five-year follow-up.Catheter Cardiovasc Interv,2005,64(2):193-196.
13. Jan SL, Hwang B,Lee PC,et al.Intracardiac ultrasound assessment of atrial septal defect:comparison with transthoracic echocardiographic,angiocardiographic,and balloon-sizing measurements.Cardiovasc Intervent Radiol,2001,24(2):84-89.
14. Rao PS,Langhough R,Beekman RH,et al.Echocardiographic estimation of balloon-stretched diameter of secundum atrial septal defect for transcatheter occlusion.Am Heart J,1992,124(1):172-175.
15.戴汝平,刘延玲,张戈军,等.应用Amplatzer封堵器介入治疗房间隔缺损疗效评价(附60例报告).中华心血管病杂志,2000,28(2):87-92.
16. Varma C,Benson LN, Silversides C,et al.Outcomes and alternative techniques for device closure of the large secundum atrial defect.Catheter Cardiovasc Inter, 2004,61(1):131-139.
17. Losay J,Petit J, Lambert V,et al.Percutaneous closure with Amplatzer device is a safe and efficient alternative to surgery in adults with large atrial septal defects.Am Heart J, 2001,142(3):544-548.
18. Durongpisitkul K, Tang NL, Soongswang J,et al.Predictors of sucessful transcatheter closure of atrial septal defect by cardiac magnetic resonance imaging.Pediatr Cardiol, 2004,25 (2): 124-130.
19. Landzberg MJ.Closure of atrial septal defects in adult patients:justification of the"tipping point"[J]. J Interven Cardiol,2001,14(2):267- 269.
20. John Sutton,Tajik AJ,McGoon DC,et al.Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up. Circula- tion,1981,64(2):402-409.
21. Chessa M,Carminati M,Butera G,et al.Early and late complications associated with transcatheter occlusion of secundum atrial septal defect.J Am Coll Cardiol ,2002,39(6): 1061-1065.
22. Preventza O, Sampath-Kumar S,Wasnick J,et al.Late cardiac perforation following transcatheter atrial septal defect closure.Ann Thorac Surg,2004,77(4): 1435-1437.
23. Chun DS,Turrentine MW,Moustapha A,et al.Development of aorta-to-right atrial fistula following closure of secundum atrial septal defect using Amplatzer septal occluder. Catheter Cardiovasc Interv,2003,58(2):246-251.
24. Verma PK,Thingnam SK,Sharma A,et al.Delayed embolization of Amplatzer septal occluder device: an unknown entity—a case report.Angiology,2003,54(l): 115-118.
25. Sharafuddin MJ,Gu X,Titus JL,et al.Trans venous closure of secumdum atrial septal defects: preliminary results with a new self-expanding nitinol prothesis in a swine model. Circulation,1997,95(8):2162-2168.
26. Hill SL,Berul CI,Patel HT,et al.Early ECG abnormalities associated with transcatheter closure of atrial septal defects using the Amplatzer septal occluder.J Inerv Card Electro-physiol,2000,4(3):469-474.
27. Ewert P,Berger F,Nagdyman N,et al.Masked left ventricular restriction in elderly patients with atrial septal defects: a contraindication for closure?Catheter Cardiovasc Interv,2001,52(2): 177-180
28. Krumsdorf U,Ostermayer S,Billinger K,et al.Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patientsJ Am Coll Cardiol,2004,43(2):302-309.
29. Anzai H,Child J,Natterson B,et al.Incidence of thrombus formation on the CardioSEAL and the Amplatzer interatrial closure devices.Am J Cardiol,2004,93(4):426-431.
30. Du ZD,Hijazi ZM,Kleinman CS,et al.Comparison between transcatheter and surgical closure of secundum afrial defect in children and adults: results of a multicenter nonran-
domized trial.J Am Coll Cardiol,2002,39(11):1836-1844.
31. Bourdages M,et al.Incidence of headaches after ASD percutaneous catheter closure with Amplatzer device.Canadian Cardiovascular Congress,2002,Edmonton,Alberta.
32. Rodes-Cabau J,Molina C,Serrano-Munuera,et al.Migraine with aura related to the percutaneous closure of an atrial septal defect.Catheter Cardiovasc Interv,2003,60(4):540-542.
33. Wilmshurst PT,Nightingale S,WaIsh KP,et al.Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons. Lancet,2000,356(9294): 1648-1651.
34. Amin Z, Hijazi ZM.Bass JL,et al.Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects :reviwe of registry of complications and recommendations to minimize future risk.Catheter Cardiovasc Interv,2004,63(4):496-502.