Berger F, Ewert P, Stiller B, Dähnert I, Krings G, Vogel M, Lange P E
Abteilung für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum Berlin.
Z Kardiol. 1998 Mar;87(3):185-90. doi: 10.1007/s003920050170.
In recent years many different systems for transcatheter closure of an atrial septal defect (ASD) have been developed and tested. However, all systems presently available have some special disadvantages. The recently introduced Amplatzer Septal Occluder (ASO), though, appears promising. It is a self-expanding and self-centering double disc made from a Nitinol mesh, which is tightly woven to give mechanical strength. Both discs are separated by a connecting cylindrical portion. Its diameter may be chosen, so that it corresponds to that of the ASD. Discs of polyester patches are sewn into the retention discs as well as into the cylindrical portion of the device in order to augment thrombogenicity. After measuring the diameter of the ASD with a balloon, an appropriate ASO is selected and advanced into the left atrium through a 7 or 8 French sheath. Then the distal disc and part of the connecting cylindrical portion is developed in the left atrium and pulled against the atrial septum, so that the cylindrical portion is occluding the ASD. Thereafter, proximal disc is deployed and the delivery cable disconnected. As long as the cable is connected to the device repositioning is easily achieved by pulling the device back into the sheath. Within a time period of 4 months in 29 out of 31 patients (median age: 12.1 years, median weight: 45.0 kg) complete closure of the ASD with a mean diameter of 11.0 mm (6-20 mm) was achieved without complications, the average fluoroscopy time being 8.3 min (2.9-21.5 min). Mean Qp:Qs was 1.5 (0.9-2.2). During a mean follow-up period of 2.1 months post implantation fixed seating of the ASO without residual shunt, arrhythmias, thrombembolic events and impairment of A-V valves was observed in all patients.
The Amplatzer septal occluder allows quick, safe, and complete closure of atrial septal defects without complications if one adheres to strict implantation criteria. For a final judgement, however, long-term follow-up studies are necessary.
近年来，已研发并测试了多种经导管闭合房间隔缺损（ASD）的不同系统。然而，目前所有可用系统都存在一些特殊缺点。不过，最近推出的Amplatzer房间隔封堵器（ASO）似乎很有前景。它是一种由镍钛诺网制成的自膨胀、自定心双盘，编织紧密以提供机械强度。两个盘由连接圆柱部分隔开。其直径可选择，使其与ASD的直径相对应。聚酯补片被缝入固定盘以及装置的圆柱部分，以增强血栓形成性。用球囊测量ASD直径后，选择合适的ASO并通过7或8F鞘管推进左心房。然后，远端盘和连接圆柱部分的一部分在左心房展开并拉向房间隔，使圆柱部分封堵ASD。此后，展开近端盘并断开输送电缆。只要电缆连接到装置，通过将装置拉回鞘管就能轻松重新定位。在31例患者中的29例（中位年龄：12.1岁，中位体重：45.0kg）的4个月时间内，平均直径为11.0mm（6 - 20mm）的ASD实现了完全闭合且无并发症，平均透视时间为8.3分钟（2.9 - 21.5分钟）。平均Qp:Qs为1.5（0.9 - 2.2）。在植入后平均2.1个月的随访期间，所有患者均观察到ASO固定在位，无残余分流、心律失常、血栓栓塞事件及房室瓣损伤。
如果严格遵循植入标准，Amplatzer房间隔封堵器可快速、安全且完全地闭合房间隔缺损而无并发症。然而，要做出最终判断，长期随访研究是必要的。
