Vogel M, Berger F, Dähnert I, Ewert P, Lange P E
Grown Up Congenital Heart Department, Middlesex Hospital, London, UK.
Cardiol Young. 2000 Sep;10(5):534-7. doi: 10.1017/s1047951100008234.
To assess results of closure of atrial septal defects within the oval fossa by devices delivered by catheterisation in symptomatic infants and children under 2 years of age.
The Amplatzer septal occluder was used. Results, and complications of transcatheter device treatment in patients aged below 2 years were compared to previous results from our institution.
We attempted closure in 12 consecutive patients below the age of 2 years who presented with an atrial septal defect between May 1997 and 1999. Symptoms were failure to thrive in 6, frequent chest infections in 5, and the need for treatment of heart failure in the other. All were thought to have a defect suitable for interventional closure. The atrial defects were seen in isolation in 10 children, but 2 had associated pulmonary stenosis which had been treated by balloon dilation prior to placement of the Amplatzer occluder.
The Amplatzer septal occluder was implanted at a mean age of 1.4 +/- 0.4, with a range from 0.8 to 1.8 years. Ratios of pulmonary-to-systemic flow had been 2.1 +/- 0.5, with a range from 1.6 and 3.2, and the defect was measured at 12 +/- 4 mms. Fluoroscopy time was 12.8 +/- 10.2 minutes, with a range from 5 to 43 minutes, and the time of the overall procedure was 162 +/- 70 minutes, with a range from 85 to 360 minutes. It proved necessary to remove the device in 2 patients (16%) because of a residual shunt and movement after release. One of these developed transient neurological complications. Both subsequently underwent surgical treatment.
Symptomatic patients less than 2 years of age can undergo successful closure of an atrial septal defect using the Amplatzer device, but the rates of success are less, and procedure time longer, than in older children or adults.
评估通过导管插入术用装置封闭2岁以下有症状婴幼儿卵圆窝房间隔缺损的结果。
使用了Amplatzer房间隔封堵器。将2岁以下患者经导管装置治疗的结果及并发症与本机构之前的结果进行比较。
1997年5月至1999年期间,我们对12例连续的2岁以下患有房间隔缺损的患者尝试进行封堵。症状表现为6例发育不良,5例频繁肺部感染,另1例需要治疗心力衰竭。所有患者均被认为有适合介入封堵的缺损。10名儿童的房间隔缺损为孤立性,但2例伴有肺动脉狭窄,在植入Amplatzer封堵器之前已通过球囊扩张进行治疗。
Amplatzer房间隔封堵器植入时的平均年龄为1.4±0.4岁,范围为0.8至1.8岁。肺循环与体循环血流量之比为2.1±0.5,范围为1.6至3.2,缺损大小为12±4毫米。透视时间为12.8±10.2分钟,范围为5至43分钟,整个手术时间为162±70分钟,范围为85至360分钟。2例患者(16%)因残余分流和释放后移位而有必要取出装置。其中1例出现短暂性神经并发症。两人随后均接受了手术治疗。
2岁以下有症状的患者使用Amplatzer装置可成功封闭房间隔缺损,但成功率低于大龄儿童或成人,且手术时间更长。