Bennhagen R G, McLaughlin P, Benson L N
The Divisions of Cardiology, The Hospital for Sick Children, The Toronto General Hospital, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Am J Cardiovasc Drugs. 2001;1(6):445-54. doi: 10.2165/00129784-200101060-00004.
Atrial septal defects that result in right atrial and ventricular volume overload should be closed if diagnosed in children and adolescents. With closure of the atrial septal defect, the left-to-right shunt is eliminated e.g. the volume loading of the right heart, the excessive pulmonary blood flow and the total cardiac work load are reduced. The possibility of future arrhythmic events is lessened and paradoxical emboli across the septum eliminated. The first intracardiac surgical repair of a congenital lesion was a defect in the atrial septum nearly 50 years ago. Surgical closure remains a valuable, although viable technique. Recently percutaneous transcatheter techniques are now available. The conventional approach is via a median sternotomy incision but is associated with pain, risk of wound infection, postoperative immobilization and a permanent scar. It has been suggested that alternative approaches such as surgical repair using mini-sternotomy or lateral thoracotomy incisions yield similar results to the conventional surgical technique and are associated with fewer adverse effects. Transcatheter closure has developed over the last two decades and has evolved into a well tolerated, efficient and cost effective method with minimal discomfort for the patients. Complete closure rates are high and this approach has become a viable option for ASD management.
如果在儿童和青少年中诊断出导致右心房和心室容量负荷过重的房间隔缺损，应予以闭合。随着房间隔缺损的闭合，左向右分流被消除，例如右心的容量负荷、过多的肺血流量和总的心脏工作负荷都会降低。未来发生心律失常事件的可能性降低，并且消除了穿过房间隔的反常栓塞。近50年前，先天性病变的首次心脏内手术修复就是房间隔缺损。手术闭合仍然是一种有价值的可行技术。最近出现了经皮导管技术。传统方法是通过正中胸骨切开术切口，但会带来疼痛、伤口感染风险、术后制动和永久性疤痕。有人提出，采用小胸骨切开术或侧胸壁切开术切口进行手术修复等替代方法，与传统手术技术产生的结果相似，且不良反应较少。经导管闭合技术在过去二十年中得到了发展，已演变成一种耐受性良好、高效且具有成本效益的方法，给患者带来的不适最小。完全闭合率很高，这种方法已成为房间隔缺损治疗的一种可行选择。
