Levi Daniel S, Moore John W
Division of Pediatric Cardiology, Mattel Children's Hospital at University of California, Los Angeles, California 90095, USA.
Catheter Cardiovasc Interv. 2004 Apr;61(4):543-7. doi: 10.1002/ccd.20011.
Embolization and percutaneous retrieval of the Amplatzer septal occluder (ASO) after release have been reported. However, the incidence, the causes of embolization, and the methods for effective retrieval have not been systematically described. In a survey of the ASO company-designated proctors, the incidence of ASO embolization in this group's experience was 0.55% (21 embolizations in 3824 device placements) with a wide range of patient demographics, atrial septal defect (ASD) sizes, and device sizes. Most embolizations occurred because of inadequate rim or undersized devices. Of the 21 embolizations, 15 of the devices were retrieved percutaneously with a gooseneck snare without morbidity or mortality. Six were retrieved at surgery. Of the 21 patients, 12 had ASO closure of their ASDs, and 9 had surgical ASD closure. In vitro, all devices could be retrieved with sheathes 2 Fr sizes larger than their recommended delivery sheath. Any device larger than 26 mm could be retrieved with its delivery sheath. The ability to pull the snared button into a sheath was variable and was assisted by pulling the device from above with a bioptome and by using a rigid notched sheath. Because the incidence of ASO embolization is about 1 in 200 in the most experienced hands, all operators should be prepared with the techniques and equipment required for percutaneous ASO retrieval.
已有关于释放后Amplatzer房间隔封堵器（ASO）栓塞及经皮取出的报道。然而，栓塞的发生率、原因及有效取出方法尚未得到系统描述。在一项针对ASO公司指定带教人员的调查中，该组经验中ASO栓塞的发生率为0.55%（3824例器械植入中有21例栓塞），涉及广泛的患者人口统计学特征、房间隔缺损（ASD）大小及器械尺寸。大多数栓塞是由于边缘不足或器械尺寸过小所致。在这21例栓塞中，15例器械通过鹅颈圈套器经皮取出，未出现并发症或死亡。6例在手术中取出。21例患者中，12例通过ASO封堵了ASD，9例通过手术封堵了ASD。在体外，所有器械均可使用比其推荐输送鞘大2 Fr尺寸的鞘管取出。任何大于26 mm的器械均可使用其输送鞘管取出。将圈套住的纽扣拉入鞘管的能力各不相同，可通过用活检钳从上方拉动器械以及使用刚性带槽鞘管来辅助。由于在经验最丰富的操作者中，ASO栓塞的发生率约为200分之一，所有操作者均应掌握经皮取出ASO所需的技术和设备。
