中国临床医学2012，Vol.19Issue(2)：122-125,4.
继发孔型房间隔缺损合并心房颤动经导管封堵的疗效观察
Effectiveness of Transcatheter Closure in Secundum-Type Atrial Septal Defect with Atrial Fibrillation
张蕾 1周达新 1管丽华 1潘文志 1葛均波1
作者信息
- 1. 复旦大学附属中山医院心内科,上海,200032
- 折叠
摘要
Abstract
Objective:To investigate the efficacy and pcriopcrativc complications of transcathctcr closure for sccundum type at-rial scptai defect (ASD) with atrial fibrillation (AF). Methods: A total of 36 patients with ASD and AF undcrment transcathctcr closure using atrial scptai defect occiudcr(ASDO) which was made in China. Patients with thrombus in left atrium or left atrial appendage took warfarin, and the prcopcrativc international normalized ratio(INR) of them were 0. 89 to 2. 63(1. 21 + 0. 38). After confirmation of no thrombus in left atrium or left atrial appendage by transcsophagcal cchocardiography (TKK) transcathctcr closure was performed under the guide of X-rays and transthoracic cchocardiography (TTE). At the 24th hours, 1st month,3rd months and 6th months after operation, electrocardiogram (ECG), chest Xrays and TTE were done. Results: Two patients abandoned intcrvcntional closure because of thrombosis of anterior cerebral artery and middle cerebral artery before operation,although no thrombus was detected in left atrium or left atrial appendage in TEE. Among the 34 remaining patients who completed the intcrvcntional therapy,one case underwent surgery due to cardiac tamponadc owing to perforation of the top of left atrium 2 hours after occlusion; two occludcrs were implanted in a double ASD case. Occludcrs were replaced in three cases. The immediate success rate was 97. 1% and the total success rate was 88. 2%. The diameters of ASDO ranged from 12 to 42 (28. 9 + 7. 9) mm. Sinus rhythm recovery without any intervention was noted in eight patients within 6 months after the closure, one patient underwent clcctro-cardiovcrsion therapy and convcrcd to sinus rhythm. Residual shunt was detected in 3 cases 24 hours after occlusion, but no residual shunt was noted in TTE within 12 months after occlusion. Conclusions: Transcathctcr closure is an effective and safe method for treating sccundum type ASD with AF after a adequate prcopcrativc anticoagulant therapy. TEE must be done before transcathctcr closure to select appropriate patients.关键词
继发孔型房间隔缺损/心房颤动/介入封堵/经食管超声心动图Key words
Sccundum atrial scptal defect/ Atrial fibrillation/ Intcrvcntional closure/ Transcsophagcal cchocardiography分类
医药卫生引用本文复制引用
张蕾,周达新,管丽华,潘文志,葛均波..继发孔型房间隔缺损合并心房颤动经导管封堵的疗效观察[J].中国临床医学,2012,19(2):122-125,4.
