Thomas Vincent C, Vincent Robert, Raviele Anthony, Diehl Helen, Qian Holly, Kim Dennis
Emory University Children's Healthcare of Atlanta, Pediatric Cardiology, 1405 Clifton Road NE, Atlanta, Georgia, USA.
Congenit Heart Dis. 2012 May-Jun;7(3):204-11. doi: 10.1111/j.1747-0803.2010.00442.x. Epub 2011 Mar 28.
Device closure of secundum type atrial septal defects in young children has now become common with extension of this practice to children less than 1 year of age. We hypothesized that patients less than 12 months of age with moderate increases in pulmonary blood flow due to atrial septal defects may improve clinically with device closure, particularly premature infants with chronic lung disease.
Thirteen patients under 12 months of age have undergone atrial septal device closure at our institution from March 2002 to July 2008, with evidence of a left to right shunt by pre-procedural echocardiogram. We evaluated concomitant conditions and device closure results. Patient charts from follow-up visits with referring pediatric cardiologists were also reviewed. Follow-up phone interviews were conducted with parents/guardians of patients who underwent device closure to further evaluate clinical change.
The patient ages ranged from 3-11 months (median 7) with weight ranges of 2.9-8.3 kg (median 6.5). Defect sizes ranged from 5-15 mm (median 9). Concomitant conditions included prematurity with bronchopulmonary dysplasia (n = 8) and concern of elevated pulmonary artery pressures (n = 5). The median Qp : Qs was 1.6 with a range of 1 to 2.6. The mean pulmonary artery pressures ranged from 16 to 55 mm Hg (median 27). Eleven of 13 patients showed significant improvement in their clinical status, with a reduction in oxygen requirement (six patients) and reduced right heart pressures by echocardiogram (four patients). There were no residual defects on follow-up echocardiograms.
Transcatheter closure of atrial septal defects in infants can be safe, effective, and may be indicated for situations in which the left to right shunt may be implicated as a cause of ongoing chronic lung disease. Moderate increases in pulmonary blood flow due to atrial septal defects may have a negative clinical impact regarding continuing respiratory insufficiency in these patients.
随着房间隔缺损封堵术在1岁以下儿童中的应用推广，小儿继发孔型房间隔缺损的器械封堵现已变得常见。我们推测，因房间隔缺损导致肺血流量适度增加的12个月以下患者，器械封堵术可能会使其临床症状改善，尤其是患有慢性肺病的早产儿。
2002年3月至2008年7月，13例12个月以下的患者在我院接受了房间隔缺损封堵术，术前超声心动图显示有左向右分流。我们评估了伴随情况和封堵结果。还查阅了转诊儿科心脏病专家随访时的患者病历。对接受封堵术患者的父母/监护人进行了随访电话访谈，以进一步评估临床变化。
患者年龄为3至11个月（中位数7个月），体重范围为2.9至8.3千克（中位数6.5千克）。缺损大小为5至15毫米（中位数9毫米）。伴随情况包括早产合并支气管肺发育不良（8例）和肺动脉压升高（5例）。Qp∶Qs中位数为1.6，范围为1至2.6。平均肺动脉压范围为16至55毫米汞柱（中位数27毫米汞柱）。13例患者中有11例临床状况有显著改善，包括吸氧需求减少（6例）和超声心动图显示右心压力降低（4例）。随访超声心动图未见残余缺损。
婴儿房间隔缺损的经导管封堵术可能是安全、有效的，对于左向右分流可能是持续性慢性肺病病因的情况可能是适用的。因房间隔缺损导致的肺血流量适度增加可能对这些患者持续的呼吸功能不全产生负面影响。
