多孔型房间隔缺损封堵器封堵小儿多孔型房间隔缺损

摘要

目的 评估新型多孔型房间隔缺损封堵器治疗小儿多发性房间隔缺损的疗效.方法 2011年10月至2012年2月收治多发性房间隔缺损患儿3例,女1例,男2例.术前完善常规检查,根据超声和心导管检查结果先选择合适球囊和封堵器进行球囊扩张和缺损封堵,术后3d出院,出院后予阿司匹林(每天3 ～5 mg/kg)口服.结果 第1例心脏超声示房间隔缺损(Ⅱ),存在3个分流口,前两者相距5.4 mm,后两者相距3.6 mm,中间孔距主动脉瓣13.2 mm,距左房室瓣10.3 mm,房间隔长约28 mm,选择25 mmCribriform封堵.第2例心脏超声示有2个分流口,两者相距3 mm,房间隔长度为35 mm,术中选取25 mm Cribriform封堵器.第3例心脏超声示房间隔缺损(多发),术中选取30 mm Cribriform封堵.所有封堵器释放后位置好,心脏超声显示无残余分流和瓣膜反流.结论 Cribriform可应用于多发性房间隔缺损的封堵,疗效可靠,并发症少,但需注意术后抗凝治疗.%Objective To evaluate the efficacy of multi - fenestrated septal occluder for transcatheter closure therapy of fenestrated atrial septal defects (ASD) in children. Methods During the period from Oct. 2011 to Feb. 2012 three patients (one female and two males) with fenestrated atrial septal defects were admitted to the hospital. Preoperative routine examinations were carefully conducted and no contra-indications were found. Based on the echocardiography and catheterization findings, the proper balloon and occluder were selected to plug the ASD. Three days after the procedure the patients were discharged from hospital. After leaving hospital the patients were asked to take Asprin (3-5 mg/kg/d) orally. Results Echocardiography showed that one case suffered from type II ASD with three shunt pores as well as PS, and the gradient pressure between PA and RV determined by echocardiography and catheterization was 70 mmHg and 52 mmHg, respectively. The diameter of the valve ring of PA was 14.4 mm and the high-pressure balloon sized 18 by 30 mm (production of BLAT) was used to dilate the PS, and after two times dilatation the gradient pressure was decreased to 36 mmHg. Echocardiography was performed to measure the ASD holes, the diameter of the three holes was 7, 1.8 and 2.9 mm respectively. The distance between two anterior holes was 5.4 mm, while the distance between two posterior holes was 3.6 mm. The distance between the middle hole and the aortic valve was 13.2 mm, and the distance between the middle hole and the mitral valve was 10.3 mm. The total septal length was 28 mm. A 25 mm Cribriform occluder was used. Echocardiography demonstrated that the second patient had ASD with two holes, the bigger one was 4.5 mm, and the small one rnwas 4 mm in diameter. The distance between the two holes was 3 mm, and the length of septum was 35 mm. A 25 mm Cribriform occluder was employed. The remaining patient had multiple AS1) with many openings. The bigger hole was about 7.2 mm in diameter, and the other holes assumed a multi -fenestrated septal defect appearance with the biggest opening being 2.5 mm in size. The length of septum was 33 mm. A 30 mm Cribriform was adopted. No residual shunt or valvular legurgitation was found alter the procedure. Conclusion Cribriform occluder can be successfully and safely used in patients with multiple ASD, however, postoperative anticoagulation therapy should be emphasized.