Tomar Munesh, Radhakrishnan Sitaraman, Shrivastava Savitri
Department of Pediatrics and Congenital Heart Diseases, Escorts Heart Institute and Research Centre, New Delhi.
Indian Heart J. 2006 Jul-Aug;58(4):325-9.
Transcatheter closure of the fossa ovalis atrial septal defect with adequate rims has become the procedure of choice in recent times. We report our experience with 439 patients who were selected for percutaneous device closure and 430 of whom underwent transcatheter closure of fossa ovalis atrial septal defects from May 1997 to May 2006. Device closure was not attempted in the remaining nine patients after initial evaluation due to high right atrial pressure following balloon occlusion (n=1 not parallel, high pulmonary vascular resistance (n=1), significant coronary artery disease (n=1), or the fact that the atrial septal defect was unsuitable for device closure (n=6). The anatomical size of the atrial septal defects ranged from 7-40 mm. Six patients underwent a combined procedure at the time of the atrial septal defect device closure (balloon pulmonary valvotomy in 4 cases, balloon pulmonary valvotomy and patent ductus arteriosus device closure in 1, and pulmonary ductus arteriosus coil closure in 1). The patients were in the age group of 2-77 years, the mean age being 20 years. Major complications occurred in seven cases. In 4 patients, there was device embolization immediately after deployment; there was left atrial appendage perforation, in one patient leading to cardiac tamponade during deployment of the device, and development of pulmonary edema in two patients. The cases in which device embolization took place underwent conventional surgery for atrial septal defect patch closure, while the patient with left atrial appendage perforation underwent emergency surgery (suturing of the left atrial appendage). Both patients with pulmonary edema were managed conservatively. The immediate success rate of device closure was 96.9%. All but one patient with multiple defects had no residual shunt at follow-up. On three months' to nine years' follow-up, the device remained stable, with no significant residual shunt and no history of thrombus formation on transthoracic echocardiography.
近年来，经导管闭合具有足够边缘的卵圆孔型房间隔缺损已成为首选治疗方法。我们报告了对439例选择经皮装置闭合术的患者的治疗经验，其中430例在1997年5月至2006年5月期间接受了卵圆孔型房间隔缺损的经导管闭合术。其余9例患者在初始评估后因球囊封堵后右心房压力高（n = 1例不平行）、肺血管阻力高（n = 1例）、严重冠状动脉疾病（n = 1例）或房间隔缺损不适合装置闭合（n = 6例）而未尝试进行装置闭合。房间隔缺损的解剖大小为7 - 40毫米。6例患者在房间隔缺损装置闭合时接受了联合手术（4例为球囊肺动脉瓣切开术，1例为球囊肺动脉瓣切开术和动脉导管未闭装置闭合术，1例为动脉导管未闭线圈闭合术）。患者年龄在2 - 77岁之间，平均年龄为20岁。发生了7例主要并发症。4例患者在装置释放后立即出现装置栓塞；1例患者在装置释放过程中发生左心耳穿孔并导致心脏压塞，2例患者出现肺水肿。发生装置栓塞的病例接受了房间隔缺损补片闭合的传统手术，左心耳穿孔的患者接受了急诊手术（左心耳缝合）。2例肺水肿患者均接受了保守治疗。装置闭合的即时成功率为96.9%。除1例有多个缺损的患者外，所有患者在随访时均无残余分流。在3个月至9年的随访中，装置保持稳定，经胸超声心动图检查无明显残余分流且无血栓形成史。
