国产封堵器介入治疗老年房间隔缺损患者的临床随访

摘要

目的 评价≥60岁老年房间隔缺损(ASD)患者经国产封堵器介入治疗后的近中期临床疗效及安全性. 方法 2007年1月至2011年12月共47例老年ASD,男11例,女36例,经胸超声心动图(TTE)测不同切面ASD的最大直径为6～34 mm,平均(17.4±8.3)inn,根据ASD边缘情况,分为中央型(18例)及边缘不足型(29例)；边缘不足型分为前缘(主动脉缘)不足型(27例),后缘(主动脉对侧缘)不足型(2例).均成功行介入治疗.手术后1、3、6、12月及每年分别行心电图、X线胸片、TTE随访,以上病例随访6月至5年. 结果 47例均1次封堵成功,所用国产封堵器直径为10～42 mm,平均(23.5±9.2)mm.术中、术后无重要并发症.随访X线胸片显示肺血较术前减少,心胸比率不同程度缩小.47例患者术后1月、3月、6月TTE即显示右房内径(RAD)、右室内径(RVD)及肺动脉收缩压(PASP)较封堵前明显缩小(P＜0.05)；术后1年(38例)、术后2年(27例)、术后3年(18例)、术后4年(8例)、术后5年(2例)随访TTE显示RAD、RVD及PASP进一步缩小(P＜0.01).所有患者近中期随访均健康生存,无封堵器介入治疗相关近中期严重并发症,无因ASD而再次接受治疗者. 结论 国产封堵器介入治疗≥60岁老年ASD患者,安全性好,技术成功率高,住院时间短,且近中期疗效满意,并发症少.%Objective To evaluate the safety and intermediate term efficacy of the transcatheter occlusion with homemade septal occluder in the treatment for secundum type atrial septal defect (ASD) in elderly patients. Methods Forty-seven cases (11 males, 36 females) of ASD with maximal dimensions from 6-34 mm ( average 17. 4 ± 8. 3 mm) were confirmed by clinical manifestation, electrocardiogram (ECG), X-ray fluoroscopy, transthoracic color Doppler echo-cardiography (TTE) from January 2007 to December 2011. According to the edge conditions, ASD were divided into central type (18 cases) and edge-insufficiency type (29 cases). Edge-insufficiency ASD included two types: aortic edge-insufficiency (27 cases) , posterior (aortic contralateral edge) edge-insufficiency (2 cases). All of them received transcatheter occlusion successfully. The patients received the detection of ECG, X-ray fluoroscopy and TTE 1,3,6, 12 months and every year after operation. Results Forty-seven cases were all occluded successfully. The size of homemade Amplatzer septal occluder was 10 -42(23. 5 ±9. 2) mm. In follow-up period, X-ray fluoroscopy showed that pulmonary venous ple-onaemia was reduced and cardio-thoracic ration was decreased. After 1, 3 and 6 months the internal diameter of atrium dex-trum and right ventricular, step-up of pulmonary arterial systolic pressure were reduced obviously ( P < 0. 05 ) , and more obviously after 1 year (38 cases) , 2 years (27 cases) , 3 years (18 cases) , 4 years (8 cases) , 5 years (2 cases) (P< 0. 01). All cases were alive and there was no significant complication in all follow-up period. Conclusions Transcatheter closure of ASD using the homemade septal occluder is safe and effective in the elderly patients, with less complication, high successful rate and short length of stay.