继发孔型房间隔缺损介入治疗效果及并发症观察

Objective To observe the effect and complications of transcatheter closure of secundum atrial septal defects(ASD) with different diameters using occluder device. Methods Under transthoracic echocardiography (TTE) and digital subtraction angiocardiography monitoring and guidance in the operation, 113 patients (77 female, 36 male) at an average age of 27.5±15.6y (range 2.5~67y) with ASD underwent an attempt at transcatheter closure of the defects. TTE were performed 5days, 3 months, 6 months, 1 year and 2 years after the procedure. Results The devices were placed correctly in 109 patients (96.5%). The average diameter of the defects measured by TTE before the procedure was 17.8mm (range 7~34mm). The average device diameter was 24mm (range 12~38mm), and 22 patients were implanted larger occluder (30mm). Among them, the defects were completely closed immediately after the procedure in 105 cases (96.3%) , mild residual shunt were observed in 4 cases (3.7%) and disappeared in 2 cases during 3-month follow-up. The complications sind inclusive non-Q-wave myocardial infarction, residual shunt and occluder dislocated. They appear all in the patients with larger occluder. In all the other patients, there was no dislocation of the occluder or residual shunt during an average 2.5 year follow-up. Premature beat and discomfort of the chest were usually observed in patients with larger occluder, during follow-up. Conclusion Transcatheter closure of secundum atrial septal defects was an efficient nonsurgical method with high successful rate, simple procedure and less trauma. But in patients with large occluder, the rate of dislocation of the occluder, residual shunt and discomfort of the chest were higher.