Zhang Yu-Shun, Lan Bei-di, Li Huan, He Xu-Mei, Dai Zheng-Xue, Wang Hai-Chang, Zhang Jun, Li Jun, DU Ya-Juan
Department of Cardiology, First Affiliated Hospital, Medical College of Xi'an Jiao-tong University, Xi'an 710061, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Nov;37(11):981-5.
To analyze factors influencing the choice of atrial septal occluder (ASO) for transcatheter closure of patients with secundum atrial septal defect (ASD).
A total of 1114 ASD patients [388 males, aged from 2 to 75 years, mean age (26.3 +/- 17.0) years] were enrolled. Patients were divided to adult (> 14 years, mean 34.4 years, n = 779) and child (< or = 14 years, mean 7.3 years, n = 335) groups. ASD size in different ultrasound cross-sections was determined by transthoracic echocardiography (TTE). ASO size was chosen on the basis of the maximum diameter of the defect (MD). Defect-shapes and rim lengths of ASD, the difference choice of ASO in the two groups were compared.
MD of the defects ranged from 5 to 40 mm [mean (19.7 +/- 7.8) mm]. ASD was successfully occluded in 1085 out of 1114 patients (97.4%). Occluder size ranged from 6 to 46 mm [mean (25.8 +/- 8.9) mm] and the difference between occluder size and MD ranged from 2 to 10 mm [mean (6.1 +/- 3.4) mm, ASO/MD ratio 1.3:1]. Though the diameter of the defect was similar between the 2 groups, the size of occluder was significantly larger in adult group than that in child group (ASO/MD ratio 1.1 - 1.6:1 vs. 1.2 - 1.8:1, P < 0.05). MD was significantly correlated with ASO in both groups (r = 0.911 and r = 0.944 in adults and child groups, respectively, all P < 0.01). The size and increment of the occluder used in patients with deficient anterior rims was significantly bigger than patients with sufficient anterior rims (P < 0.01).
The maximum diameter of the defect was the major determinant for selecting occluder size and choice of occluder size was also influenced by patient age, defect-shape and defect rim for transcatheter closure of secundum ASD.
分析影响继发孔型房间隔缺损（ASD）患者经导管封堵术中房间隔封堵器（ASO）选择的因素。
共纳入1114例ASD患者[男性388例，年龄2至75岁，平均年龄（26.3±17.0）岁]。患者分为成人组（>14岁，平均34.4岁，n = 779）和儿童组（≤14岁，平均7.3岁，n = 335）。通过经胸超声心动图（TTE）测定不同超声切面的ASD大小。根据缺损最大直径（MD）选择ASO大小。比较ASD的缺损形状和边缘长度，以及两组中ASO的不同选择。
缺损的MD范围为5至40mm[平均（19.7±7.8）mm]。1114例患者中有1085例（97.4%）ASD封堵成功。封堵器大小范围为6至46mm[平均（25.8±8.9）mm]，封堵器大小与MD的差值范围为2至10mm[平均（6.1±3.4）mm，ASO/MD比值为1.3:1]。虽然两组间缺损直径相似，但成人组封堵器大小显著大于儿童组（ASO/MD比值为1.1 - 1.6:1对1.2 - 1.8:1，P < 0.05）。两组中MD与ASO均显著相关（成人组和儿童组的r分别为0.911和0.944，均P < 0.01）。前边缘不足患者所用封堵器的大小及增量显著大于前边缘充足患者（P < 0.01）。
缺损最大直径是选择封堵器大小的主要决定因素，对于继发孔型ASD的经导管封堵，封堵器大小的选择还受患者年龄、缺损形状和缺损边缘的影响。
