The Prince Charles Hospital, Rode Rd., Chermside, QLD 4032, Australia.
Heart Lung Circ. 2012 Sep;21(9):572-5. doi: 10.1016/j.hlc.2012.05.001. Epub 2012 Jun 5.
To assess the clinical and echocardiographic outcomes in patients referred for device closure of atrial septal defects in a tertiary referral hospital in Australia.
A prospective follow-up study was performed on all patients who had device closure of a secundum atrial septal defect (ASD) from June 1999 to December 2007. Clinical and echocardiographic data at the time of implantation and follow-up is presented.
176 patients were referred for shunt closure of ASD. All patients had a significant shunt defined as a shunt with right heart dilatation and/or a shunt ratio of at least 1.5:1. The majority were female (67%) and the average age was 36.5 ± 22.7 years; age range 3-84. The average hospital admission time was 2.5 ± 1.7 days. The average follow-up occurred at 3.7 ± 3.6 months for the first follow-up and 26.3 ± 18.2 months (range 3 months-7.8 years) for the long-term follow-up. Baseline echocardiogram findings showed the majority had a normal left ventricular ejection fraction (99%); average LVEF=63.2 ± 7.2% while the right ventricle was dilated in 61% of patients. Procedure information: The average procedure time was 94.8 ± 36.4 min. Procedural imaging was performed using Transoesophageal echocardiography (TOE) in 107 cases (61%); Intracardiac Echocardiography (ICE) in 69 (39%). Device use was as follows: Amplatzer=156 cases, Helex=18, and Starflex=2. Postprocedure shunt assessment by transthoracic echocardiography showed successful closure (no shunt or trivial shunt) in 99% cases. Two patients were referred for inpatient surgery due to a significant residual shunt in one case and an unstable device in another. One patient who had an unstable device had their device repositioned successfully. Atrial arrhythmia was the most common complication occurring in the peri-implantation period in 12 cases (6%) with four further cases at final up. The high prevalence of right ventricular dilatation in 65% patients at baseline had improved significantly at the first and long term follow-up to 2% (p=0.0001).
Device closure of secundum atrial septal defects in this large Australian cohort demonstrates a high procedural success rate with a low incidence of complications in the short and long term.
评估在澳大利亚一家三级转诊医院接受设备关闭房间隔缺损的患者的临床和超声心动图结果。
对 1999 年 6 月至 2007 年 12 月期间接受设备关闭继发房间隔缺损（ASD）的所有患者进行前瞻性随访研究。介绍了植入和随访时的临床和超声心动图数据。
176 例患者因分流关闭 ASD 而被转介。所有患者均存在明显分流，定义为右心扩张和/或分流比至少为 1.5:1。大多数为女性（67%），平均年龄为 36.5±22.7 岁；年龄范围为 3-84 岁。平均住院时间为 2.5±1.7 天。第一次随访的平均随访时间为 3.7±3.6 个月，长期随访为 26.3±18.2 个月（范围为 3 个月-7.8 年）。基线超声心动图检查结果显示，大多数患者左心室射血分数正常（99%）；平均 LVEF=63.2±7.2%，而 61%的患者右心室扩张。手术信息：平均手术时间为 94.8±36.4 分钟。107 例（61%）采用经食管超声心动图（TOE）进行术中影像学检查；69 例（39%）采用心内超声心动图（ICE）。器械使用情况如下：Amplatzer=156 例，Helex=18 例，Starflex=2 例。经胸超声心动图显示，术后分流评估显示 99%的病例成功关闭（无分流或轻度分流）。由于一例存在明显残余分流，两例不稳定装置，两例患者转内科手术。一例不稳定装置的患者成功重新定位了他们的装置。心房心律失常是植入期最常见的并发症，12 例（6%），最后有 4 例。基线时 65%的患者右心室扩张率显著改善，在第一次和长期随访时降至 2%（p=0.0001）。
在澳大利亚的这一大队列中，采用设备关闭继发房间隔缺损的方法具有很高的手术成功率，在短期和长期内并发症发生率都较低。
