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目的:探讨特殊类型房间隔缺损(ASD)介入治疗的适应证及注意事项,观察其术后远期疗效及安全性。方法:我院1999-12-2009-01期间经胸和(或)经食管超声心动图(TTE、TEE)行术前筛选并成功随访的特殊类型ASD患者116例,评估后应用房间隔封堵器(ASO)介入封堵,于术后远期随访观察并发症的发生,同时追踪心脏超声及心电图变化。结果:所有患者术后随访40～120(90±46)个月。111例封堵成功,技术成功率95.7%;随访中发生严重并发症4例(3.6%),其中1例封堵器脱落,1例溶血,1例脑栓塞及1例明显主动脉瓣反流;手术成功率为94.8%(110/116);9例(8.2%)术后即刻有残余分流,随访中5例分流消失,完全封闭率96.4%;ASD患者术后心脏重构较术前显著改善,尤以年龄<18岁者改善明显;术前心电图2例存在室上性心动过速,随访中未见再发作;5例心房颤动,随访中2例恢复窦性心律,未见室性心律失常,24例原有右束支传导阻滞,术后6例消失。结论:术前了解ASD解剖细节,严格掌握适应证是ASO治疗特殊类型ASD手术成功的关键,远期随访疗效肯定。
Objective: To investigate the indications and precautions of interventional treatment of special type of atrial septal defect (ASD) and to observe its long-term efficacy and safety after surgery. Methods: One hundred and sixty-six patients with ASD who underwent transthoracic and / or transthoracic echocardiography (TTE) before and during follow-up during 1999-12-2009-01 in our hospital were enrolled. Atrial septal closure (ASO) was involved in the occlusion. The long-term postoperative follow-up was performed to observe the complications and to track the changes of echocardiography and cardiogram. Results: All patients were followed up for 40 to 120 (90 ± 46) months. 111 cases were successfully occluded, and the technical success rate was 95.7%. Four (3.6%) serious complications occurred during the follow-up. One of them occluded, one had hemolysis, one had cerebral embolism and one had obvious aortic regurgitation . The success rate of operation was 94.8% (110/116). Residual shunt occurred immediately after operation in 9 cases (8.2%). In 5 cases, the shunt disappeared and the complete occlusion rate was 96.4%. The postoperative cardiac remodeling in ASD patients was significantly Improvement, especially in <18 years of age to improve significantly; preoperative ECG in 2 cases of supraventricular tachycardia, no recurrence of follow-up; 5 cases of atrial fibrillation, follow-up in 2 cases to restore sinus rhythm, no ventricular Arrhythmia, 24 cases of the original right bundle branch block, 6 cases disappeared. Conclusion: To understand the anatomic details of ASD preoperatively and to strictly observe the indications are the key to successful ASO in the treatment of special type of ASD. The long-term follow-up effect is sure.