房间隔缺损封堵器相关严重并发症的原因分析
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摘要
目的分析继发型房间隔缺损介入封堵后封堵器相关严重并发症的原因和防治方法。方法回顾性分析2008年至2017年在云南省多个介入中心行介入封堵治疗的继发型房间隔缺损患者1 214例的临床资料。将患者分为封堵器与心脏大血管接触组(n=1 030例)、封堵器与心脏大血管未接触组(n=184例)。封堵器与心脏大血管接触组又依据接触是否成角及封堵器有无相对活动分为相应亚组。结果全组共发生封堵器相关严重并发症6例(0.5%),其中封堵器脱落5例,主动脉右心房瘘1例;当封堵器与大动脉呈切线位接触且无相对活动时,封堵器相关严重并发症减少。结论建议根据不同的房间隔缺损选择适合的封堵器,封堵器释放前应关注封堵器是否与大动脉接触成角以及有相对运动。
ObjectivesTo analyze the causes and control methods of serious complications caused by atrial septal defect(ASD)occluder.MethodsWe reviewed and analyzed 1 214 patients with secondary ASD who received ASD occluder in multiple intervention centers in Yunnan from 2008 to 2017. The patients were divided into occluder contacting major heart vessel group(n=1030 cases)and occluder not contacting major heart vessel group(n=184 cases). Occluder contacting major heart vessel group were further divided into corresponding subgroups according to whether the contact was angular or not and whether the occluder had relative activity.ResultsThere were 6 patients(0.5 %)had severe complications related to ASD occluder,of which,5 cases with occluder dropping and 1 case with aorta right atrium fistula. When the occluder was in contact with the major artery and there was no relative activity,the serious complications associated with ASD occluder decreased.ConclusionsWe suggest that according to the different ASD,the suitable ASD occluder should be selected. Before the ASD occluder is released,it should be paid attention to whether the ASD occluder is in contact with the aorta and has relative motion.
ObjectivesTo analyze the causes and control methods of serious complications caused by atrial septal defect(ASD)occluder.MethodsWe reviewed and analyzed 1 214 patients with secondary ASD who received ASD occluder in multiple intervention centers in Yunnan from 2008 to 2017. The patients were divided into occluder contacting major heart vessel group(n=1030 cases)and occluder not contacting major heart vessel group(n=184 cases). Occluder contacting major heart vessel group were further divided into corresponding subgroups according to whether the contact was angular or not and whether the occluder had relative activity.ResultsThere were 6 patients(0.5 %)had severe complications related to ASD occluder,of which,5 cases with occluder dropping and 1 case with aorta right atrium fistula. When the occluder was in contact with the major artery and there was no relative activity,the serious complications associated with ASD occluder decreased.ConclusionsWe suggest that according to the different ASD,the suitable ASD occluder should be selected. Before the ASD occluder is released,it should be paid attention to whether the ASD occluder is in contact with the aorta and has relative motion.
引文
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[6]FDA’s on-line MAUDE database.Available at:http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm.
[7]OMELCHENKO A,GORBATYKH Y,VOITOV A,et al.Perventricular device closure of ventricular septal defects:results in patients less than 1 year of age[J].Interact Cardiovasc Thorac Surg,2016,22(1):53-56.
[8]YANG J,YANG L,WAN Y,et al.Transcatheter device closure of perimembranous ventricular septal defects:mid-term outcomes[J].Eur Heart J,2010,31(18):2238-2245.
[9]BARTEL T,BONATTI J O,MüLLER S.Device dislocation,probably due to paroxysmal coughing early after percutaneous closure of secun-dum type atrial septal defect[J].Am JCardiol,2008,101(4):548-549.2018-09-06
[2]MOORE J,HEGDE S,EL-SAID H,et al.Transcatheter device closure of atrial septal defects[J].JACC Cardiovasc Interv,2013,6(5):433-42.
[3]DU Z D,CAO Q L,RHODES J,et al.Choice of device size and results of transcatheter closure of atrial septal defect using the amplatzer septal occluder[J].J Interv Cardiol,2002,15(4):287-292.
[4]WANG J K,TSAI S K,LIN S M,et al.Transcatheter closure of atrial septal defect without balloon sizing[J].Cathet Cardiovasc Interv,2008,71(2):214-221.
[5]DU Z D,KOENIG P,CAO Q L,et al.Comparison of transcatheter closure of secundum atrial septal defect using the Amplatzer septal occluder associated with deficient versus suffi cient rims[J].Am J Cardiol,2002,90(8):865-869.
[6]FDA’s on-line MAUDE database.Available at:http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm.
[7]OMELCHENKO A,GORBATYKH Y,VOITOV A,et al.Perventricular device closure of ventricular septal defects:results in patients less than 1 year of age[J].Interact Cardiovasc Thorac Surg,2016,22(1):53-56.
[8]YANG J,YANG L,WAN Y,et al.Transcatheter device closure of perimembranous ventricular septal defects:mid-term outcomes[J].Eur Heart J,2010,31(18):2238-2245.
[9]BARTEL T,BONATTI J O,MüLLER S.Device dislocation,probably due to paroxysmal coughing early after percutaneous closure of secun-dum type atrial septal defect[J].Am JCardiol,2008,101(4):548-549.2018-09-06