Ewert P, Berger F, Vogel M, Dähnert I, Alexi-Meshkishvili V, Lange P E
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Heart. 2000 Sep;84(3):327-31. doi: 10.1136/heart.84.3.327.
To define the morphological criteria of perforated atrial septal aneurysms suitable for closure by a transcatheter device.
A retrospective analysis of all consecutive patients with atrial septal aneurysm and one or more perforations presenting between May 1997 and June 1999. The aneurysms were classified as: aneurysm with persistent foramen ovale (type A); aneurysm with single atrial septal defect (type B); aneurysm with two perforations requiring more than one device for closure (type C); and aneurysm with multiple perforations (type D).
Data from 50 patients aged 5-78 years (mean 43 years) were analysed; 32 had systemic thromboembolism or transient ischaemic attacks, eight presented with dyspnoea on exercise, and 10 were discovered incidentally but had significant left to right shunt and right ventricular volume overload.
In all 18 patients with aneurysm and persistent foramen ovale (type A), transcatheter closure was possible. In nine with aneurysm and atrial septal defect (type B), five defects were closed and four required surgery. Device closure was achieved in all 10 patients with aneurysms and two perforations (type C), but four had a residual shunt. Thirteen patients with multiple perforated aneurysms (type D) underwent surgery.
This classification of morphology of perforations of aneurysm is clinically useful for selecting patients for treatment by transcatheter devices.
确定适合经导管装置封堵的穿孔性房间隔瘤的形态学标准。
对1997年5月至1999年6月间所有连续的房间隔瘤合并一个或多个穿孔的患者进行回顾性分析。这些动脉瘤分为：伴有持续性卵圆孔未闭的动脉瘤（A型）；伴有单个房间隔缺损的动脉瘤（B型）；伴有两个穿孔且需要不止一个装置封堵的动脉瘤（C型）；以及伴有多个穿孔的动脉瘤（D型）。
分析了50例年龄在5至78岁（平均43岁）患者的数据；32例有系统性血栓栓塞或短暂性脑缺血发作，8例运动时出现呼吸困难，10例为偶然发现，但有明显的左向右分流和右心室容量负荷过重。
所有18例伴有持续性卵圆孔未闭的动脉瘤患者（A型）均可行经导管封堵。9例伴有房间隔缺损的动脉瘤患者（B型）中，5个缺损得以封堵，4个需要手术治疗。所有10例伴有两个穿孔的动脉瘤患者（C型）均成功进行了装置封堵，但4例有残余分流。13例伴有多个穿孔的动脉瘤患者（D型）接受了手术治疗。
这种动脉瘤穿孔形态学分类对于选择经导管装置治疗的患者具有临床实用性。
