论文部分内容阅读
目的 探讨应用Amplatzer双盘闭合器关闭小儿继发孔房间隔缺损 (ASD)的临床效果。方法 71例ASD患儿。男 33例 ,女 38例 ;年龄 2～ 15岁 ,平均 (7± 4)岁 ;体重 10～ 5 0kg ,平均 (2 2±11)kg。在经胸超声 (TTE)的四腔心切面和剑下切面观察ASD的位置并测量ASD直径 ,测量房间隔(IAS)直径。在X线和超声帮助下用Amplatzer测量球囊导管测量ASD最大伸展径。根据所测得的ASD伸展径选择与之相同或比ASD大 1～ 2mm腰部直径的Amplatzer闭合器堵闭 71例患儿的ASD。术后随访疗效 ,追踪残余分流率和并发症。结果 应用此法关闭 71例ASD ,全部成功。其残余分流率为 2 8%。此方法并发症较少 ,疗效较好。本组资料分析示TTE测得的ASD径与测量球囊导管测得的ASD伸展径相关性好 ,从TTE测得的ASD径推算ASD伸展径的直线回归方程式 :6 5 4+ 0 97×TTE测得的ASD径 (心尖四腔心 )。结论 经导管关闭继发孔ASD适应证为 :(1)年龄≥ 2岁 ,体重≥10kg,ASD直径≤ 30mm的单纯继发孔ASD或合并肺动脉瓣狭窄 ;(2 )IAS≥ASD伸展径 + 14mm ;(3)ASD下缘与二尖瓣距离 >5mm ,上下腔缘、后缘≥ 5mm ,前缘≥ 2mm。超声心动图对病例的选择和对经导管监视关闭ASD术有不可忽略的作用 ,TEE还能弥补TTE的不足。Amplatzer双盘闭合器关闭ASD在儿科?
Objective To investigate the clinical effect of Amplatzer double-disk closure on the closure of pediatric secondary atrial septal defect (ASD). Methods 71 children with ASD. There were 33 males and 38 females. The average age was from 2 to 15 years old (7 ± 4) years old. The body weight was from 10 to 50 kg (mean, 2 ± 11) kg. The position of ASD was observed under transthoracic echocardiography (TTE) in the four-chamber and sternotomy sections and the ASD diameter was measured to measure the atrial septum (IAS) diameter. Balloon catheters were measured with Amplatzer with the help of X-rays and ultrasound to measure the maximum ASD diameter. Seventy children with ASD were selected according to the measured diameter of ASD expansion. Amplatzer occluders with the same or 1 ~ 2mm waist diameter as the ASD were selected. Follow-up efficacy, follow-up residual shunt rate and complications. Results of this method to close 71 cases of ASD, all successful. The residual shunt rate was 28%. This method less complications, better effect. The data analysis showed that TTE measured ASD diameter and measurement of balloon catheter ASD measured diameter correlation is good, measured from the TTE ASD diameter calculated ASD stretch diameter linear regression equation: 6 5 4 + 0 97 × TTE Measured ASD diameter (apical four-chamber heart). CONCLUSIONS: The ASD indications for secondary hole closure by catheter are: (1) simple secondary ASD or pulmonary valve stenosis with ASD diameter ≤ 30 mm, age ≥ 2 years, body weight ≥ 10 kg, and (2) IAS ≥ ASD extension diameter + 14 mm ; (3) ASD lower edge and mitral valve distance> 5mm, upper and lower cavity edge, trailing edge ≥ 5mm, leading edge ≥ 2mm. Echocardiographic choice of cases and the closure of ASD by catheter monitoring can not be ignored, TEE can make up for the lack of TTE. Amplatzer Double Disk Closer Close ASD in Pediatrics?