Chan K Y, Yip W C, Godman M J
Singapore Baby & Child Clinic, Gleneagles Medical Centre, Singapore.
J Paediatr Child Health. 1998 Aug;34(4):369-73. doi: 10.1046/j.1440-1754.1998.00240.x.
To discuss the initial experience with the use of a new double disc occluding device, the Amplatzer septal occluder in transcatheter occlusion of secundum atrial septal defects (ASD).
Transvenous sizing of secundum ASD was performed in five children under general anaesthesia using transoesophageal echocardiographic and fluoroscopic guidance. An Amplatzer septal occluder equal to or minimally larger than the stretched diameter of the ASD was used for transcatheter occlusion of the defect in three suitable patients. Pulmonary balloon valvuloplasty with a 18 mm x 3 cm Mansfield balloon catheter was carried out in one patient with associated pulmonary valvar stenosis in the same procedure setting.
Stretched diameters of the defects in the three patients ranged from 14 to 17 mm. Devices of sizes 14, 17 and 17 were deployed through 7F and 8F sheaths, respectively. The upper and lower rims of interatrial septum were more than 8 mm in all patients. All patients had successful occlusion with complete obliteration of the atrial left to right shunting. Simultaneous pulmonary balloon valvuloplasty for the valvar stenosis reduced pressure gradient from 53 mmHg to 22 mmHg across the valve prior to septal occlusion in one patient. No intraprocedural or short-term complication was encountered.
The design of the Amplatzer septal occluder permits ease in loading, delivery, deployment and stable seating of the device. This initial experience shows that Amplatzer device occlusion is feasible, relatively safe and effective and appears to be a viable alternative to surgical closure of secundum atrial septal defects in properly selected patients.
探讨使用新型双盘封堵装置——Amplatzer房间隔封堵器经导管封堵继发孔型房间隔缺损（ASD）的初步经验。
在全身麻醉下，对5例儿童经食管超声心动图和荧光透视引导行经静脉测量继发孔型ASD大小。在3例合适的患者中，使用等于或略大于ASD伸展直径的Amplatzer房间隔封堵器经导管封堵缺损。在同一手术过程中，对1例合并肺动脉瓣狭窄的患者使用18mm×3cm的Mansfield球囊导管进行肺动脉球囊瓣膜成形术。
3例患者缺损的伸展直径为14至17mm。分别通过7F和8F鞘管置入尺寸为14、17和17的封堵器。所有患者房间隔的上下边缘均超过8mm。所有患者封堵成功，心房左向右分流完全消失。1例患者在封堵房间隔前，同时对瓣膜狭窄进行肺动脉球囊瓣膜成形术，使瓣膜压力阶差从53mmHg降至22mmHg。术中及短期均未出现并发症。
Amplatzer房间隔封堵器的设计便于封堵器的装载、输送、置入及稳定固定。这一初步经验表明，Amplatzer封堵器封堵可行、相对安全有效，对于合适患者似乎是继发孔型房间隔缺损手术闭合的可行替代方法。
