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目的探讨经导管封堵治疗老年继发孔型房间隔缺损(ASD)的有效性和安全性。方法回顾性分析经导管封堵治疗的32例老年ASD患者的临床和介入治疗资料。结果全组技术成功率为100%(32/32例);TTE测量ASD平均大小17.4±5.3mm,封堵器平均大小22.4±6.7mm;19例采用Amplatzer房间隔封堵器,13例采用国产封堵器;术前平均肺动脉收缩压36.0±9.3mmHg(1mmHg=0.133kPa),肺循环血流量/体循环血流量(Qp/Qs)平均为1.9±0.7。ASD的完全堵闭率即刻为93.8%(30/32例),术后24h为96.9%,术后6个月仍有1例(3.1%)残余分流,为双孔型缺损。并发症发生率6.3%(2/32例),其中操作相关并发症1例(3.1%),为心包填塞(疑肺静脉破裂),无操作相关死亡。术后发生血管迷走反应1例。术后心律失常5例(15.6%),均为房颤。平均随访18.9±12.5个月(9～60个月),无封堵器移位、脱落或金属骨架断裂,无晚发心脏穿孔或心包填塞。结论经导管封堵治疗老年ASD安全、有效,在适应证的范围内可替代外科手术。
Objective To investigate the efficacy and safety of transcatheter closure of secundum atrial septal defect (ASD) in the elderly. Methods The clinical and interventional data of 32 ASD patients treated by catheterization were retrospectively analyzed. Results The technical success rate of the whole group was 100% (32/32 cases). The average size of ASD measured by TTE was 17.4 ± 5.3mm and the average size of occluder was 22.4 ± 6.7mm. Amplatzer atrial septal occluder was used in 19 cases, The preoperative average pulmonary artery systolic blood pressure was 36.0 ± 9.3mmHg (1mmHg = 0.133kPa), and pulmonary circulation blood flow / systemic blood flow (Qp / Qs) was 1.9 ± 0.7. The complete occlusion rate of ASD was 93.8% (30/32 cases) immediately after operation, 96.9% after operation, and there was still 1 case (3.1%) remaining shunt at 6 months after operation. The incidence of complications was 6.3% (2/32 cases). Among them, 1 case (3.1%) had operation-related complications, which was pericardial stuffing (suspected pulmonary vein rupture) without any operation-related death. Postoperative vasovagal reaction in 1 case. Arrhythmia in 5 cases (15.6%) were atrial fibrillation. The average follow-up was 18.9 ± 12.5 months (range, 9 to 60 months). No occluder displacement, exfoliation, or rupture of the metal skeleton occurred. No late perforation or tamponade was observed. Conclusion Transcatheter closure of senile ASD is safe and effective and can replace surgery within the scope of indication.