Bilgiç A, Celiker A, Ozkutlu S, Ayabakan C, Karagöz T, Ocal T
Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2001 Jan-Mar;43(1):12-8.
We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.
我们报告了使用新开发的Amplatzer装置经导管封堵9例房间隔缺损（ASD）、1例室间隔缺损（VSD）和1例动脉导管未闭（PDA）的临床经验。根据经食管超声心动图（TEE）检查的缺损部位和大小，选择了11例ASD患者（年龄范围2.5 - 18岁）、1例5岁的肌部VSD患者和1例1岁的PDA患者，考虑使用Amplatzer装置进行经导管封堵。所有手术均在全身麻醉下，在荧光透视和TEE引导下进行，术前在导管室进行常规血流动力学评估。ASD经球囊测量大小后选择最佳装置尺寸。VSD和PDA的大小通过TEE和血管造影测量。患者在经过X线、心电图（ECG）和超声心动图评估后24小时出院；术后服用3 - 5mg/kg/天的阿司匹林并进行6个月的感染性心内膜炎预防。术后6至8周进行复查，并加做动态心电图监测。该装置用于9例ASD患者以及VSD和PDA患者。TEE测量的ASD平均大小为14.3±5.3mm，球囊测量时为18.3±4.3mm（p = 0.02）。装置平均大小为18.7±4.2mm。手术时间和透视时间分别为46.1±12.3分钟和12.9±1.6分钟。术后即刻，4例患者（44%）有微量分流（TS）。出院时仅2例仍有TS，二次评估时未观察到分流。该装置同样应用于VSD（12 - 7mm）和PDA（8 - 6mm）患者。两例术后即刻均有TS，但24小时时消失。所有患者均无重大并发症。1例患者出现交界性心律，另1例患者有频发室上性早搏。Amplatzer是一种用于经导管封堵ASD、VSD或PDA的有效且安全的装置，尤其适用于儿科患者。
