Białkowski J, Szkutnik M, Wilczek K, Chodór B, Zeifert B, Sikora J, Szatkowski K, Haponiuk I, Zembala M
Oddział Kliniczny Kardiologii Dzieciecej, Sl. Centrum Chorób Serca w Zabrzu.
Pol Arch Med Wewn. 2001 Apr;105(4):303-9.
In many centres the Amplatzer Septal Occluder (ASO) (AGA Med. Corp. Minnesota, USA) has become the device of choice for secundum atrial septal defect (ASD) closure in children. Current trend towards transcatheter closure of ASD in children could be translated to adults and many patients (pts) may avoid the need of open heart surgery. Assessment the efficacy and complication of device occlusion of ASD in adults, using ASO. Between October 1997 and April 2001 transcatheter closure of ASD was attempted in 51 pts who fulfilled the inclusion criteria--significant shunt with sufficient rims of interatrial septum. Mean age of pts was 29 (16-63) y, mean ASD diameter assessed by transesophageal echocardiography (TEE) was 14.7 (7-24) mm, assessed during catheterization by balloon sizing (stretched diameter) was 20.2 (8-36) mm. There were 9 pts with multiple ASDs, 2 pts with aneurysm of interatrial septum and 2--after previous surgery (recanalization of ASD). The ASO devices were successfully implanted in all, but one pt. In one patient because of unstable position of ASO (floppy rims), device was removed and bigger one was applied during next session. In one case early embolization to abdominal aorta occurred, ASO was translocated to aortic arch with Dotter basket and removed from aorta during simultaneous surgical closure of ASD. Mean fluoroscopy time was 15 (4-50) min. The occlusion rate after 24 h was 90%, after 1 month (m) 92%, after 3 m 93.5%, after 1 year (y) 93.3% and after 2 y 93.3%. All residual shunts were trivial. There were no late complication.
The excellent results of ASD closure with ASO in adults indicate this treatment as a method of choice in selected patients, but long term follow-up is necessary to state final judgement.
在许多中心，Amplatzer房间隔封堵器（ASO）（美国明尼苏达州AGA医疗公司）已成为儿童继发孔型房间隔缺损（ASD）封堵的首选器械。目前儿童ASD经导管封堵的趋势可能会应用于成人，许多患者可能无需进行心脏直视手术。评估使用ASO对成人ASD进行器械封堵的疗效和并发症。1997年10月至2001年4月，对51例符合纳入标准的患者尝试进行ASD经导管封堵——存在明显分流且房间隔有足够边缘。患者的平均年龄为29（16 - 63）岁，经食管超声心动图（TEE）评估的平均ASD直径为14.7（7 - 24）mm，在导管插入术中通过球囊测量（拉伸直径）评估为20.2（8 - 36）mm。有9例患者存在多个ASD，2例患者有房间隔瘤，2例患者曾接受过手术（ASD再通）。除1例患者外，所有患者的ASO器械均成功植入。1例患者因ASO位置不稳定（边缘松软），在下一次手术中移除了该器械并应用了更大的器械。1例患者发生早期栓塞至腹主动脉，通过Dotter网篮将ASO转移至主动脉弓，并在同时进行ASD手术闭合时从主动脉中取出。平均透视时间为15（4 - 50）分钟。24小时后的封堵率为90%，1个月后为92%，3个月后为93.5%，1年后为93.3%，2年后为93.3%。所有残余分流均很轻微。无晚期并发症。
成人使用ASO封堵ASD的效果良好，表明该治疗方法是部分患者的首选，但需要长期随访才能做出最终判断。
