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目的探讨采用小腰大边型的房间隔缺损封堵器(ASO)介入治疗房间隔缺损(ASD)合并房间隔膨出瘤(ASA)的安全性及有效性。方法选取2008年7月至2017年3月沈阳军区总医院收治的ASD合并ASA患者78例为研究对象。本组患者术前行经胸超声(TTE)或经食道超声(TEE)检查,诊断为ASD合并ASA。其中,合并多个(2个及以上)缺损的患者45例,测量ASA基底部直径为10.0~36.0 mm,平均直径(22.2±6.2)mm;缺损直径为3.0~16.0 mm(多发缺损以较大孔直径为主),平均直径(8.6±3.1)mm。术后1、3、6个月行TTE复查,并观察患者的右心房前后径、左右径,右心室内径变化情况。结果所有患者均成功植入小腰大边型ASO,封堵器对毗邻结构均无影响。术后即刻,TTE示70例完全闭合,8例有少量残余分流但无血流动力学意义,完全闭合率89.7%(70/78);术后1个月复查TTE,有3例微量残余分流,完全闭合率96.2%(75/78);术后6个月复查TTE,有1例微量残余分流,完全闭合率98.7%(77/78)。术后3 d,1、3、6个月TTE测量右心房、右心室内径,均较术前缩小(P<0.05)。手术过程未出现心脏穿孔、封堵器脱落等不良反应。结论采用小腰大边型ASO封堵ASD合并ASA,可以避免使用多个封堵器,最大限度的遮盖缺损和ASA,明显降低术后残余分流的发生率,在临床上是一种安全、有效的治疗方法。
Objective To investigate the safety and efficacy of ASO interventional treatment of atrial septal defect (ASA) with ASA. Methods From July 2008 to March 2017, Shenyang Military Region General Hospital 78 cases of ASD ASA patients were selected as the research object. The patients underwent preoperative thoracic ultrasound (TTE) or transesophageal echocardiography (TEE) examination, diagnosed as ASD with ASA. Among them, there were 45 patients with multiple (2 or more) defects. The diameter of basal portion of ASA was 10.0 ~ 36.0 mm and average diameter was 22.2 ± 6.2 mm, and the diameter of defect was 3.0 ~ 16.0 mm Hole diameter mainly), the average diameter (8.6 ± 3.1) mm. TTE was performed at 1, 3, and 6 months after operation, and the anteroposterior diameter, right and left diameter, and right ventricular diameter of the right atrium were observed. Results All the patients were successfully implanted with small lumbar ASO. The occluder had no effect on the adjacent structures. Immediately after operation, TTE showed 70 cases were completely closed, 8 cases had a small amount of residual shunt but no hemodynamic significance, the complete closure rate was 89.7% (70/78); 1 month after the review of TTE, 3 cases of trace residual shunt , Complete closure rate 96.2% (75/78); 6 months after the review of TTE, a trace residual shunt, the complete closure rate was 98.7% (77/78). The TTE measurements of right atrium and right ventricle at 3 d, 1, 3 and 6 months after operation were both smaller than those before operation (P <0.05). No perforation of heart during surgery, occluder shedding and other adverse reactions. Conclusion Small ASD ASA with ASA occlusion can avoid the use of multiple occluders to maximally cover the defect and ASA and significantly reduce the incidence of postoperative residual shunt, which is clinically a safe and effective method The treatment.