超声心动图引导下行经皮动脉导管未闭封堵术的临床研究

目的探讨使用超声心动图作为唯一影像学工具行经皮动脉导管未闭(PDA)封堵术的安全性和有效性。方法回顾性分析2013年8月至2016年4月在中国医学科学院阜外医院接受单纯超声心动图引导下经皮PDA封堵术200例患者的临床资料。根据封堵血管径路的不同,将患者分为经股动脉途径组(n=143)和经股静脉途径组(n=57)。其中经股动脉途径组,男42例、女101例,年龄(3.20±5.63)岁;经股静脉途径组,男10例、女47例,年龄(7.30±11.36)岁。所有患者术后1个月在门诊随访超声心动图、胸部X线片及心电图。结果 200例患者均成功置入封堵器。两组患者的性别、住院时间、封堵器脱落率差异均无统计学意义(P0.05)。与经股静脉途径组相比,经股动脉途径组患者年龄较小[(3.20±5.63)岁vs.(7.30±11.36)岁,P0.001]、体质量较轻[(14.25±11.54)kg vs.(24.25±19.14)kg,P0.001],PDA直径和封堵器直径较短[(3.06±0.79)mm vs.(5.93±0.68)mm,P0.001;(5.43±1.00)mm vs.(12.14±0.54)mm,P0.001],但住院费用较高[(32 108.2±3 100.2)元vs.(25 120.7±3 534.1)元,P0.001]。经股静脉途径组有1例患者术中因导丝通过PDA困难而改行放射线引导下封堵成功。经股动脉途径组有1例患者(PDA直径4.5 mm)术后1 d封堵器脱落,急诊开胸行封堵器取出后经胸动脉导管封堵术封堵成功。所有患者均顺利出院。两组患者在术后随访期内均无封堵器脱落、残余分流、心包积液、左肺动脉狭窄等并发症发生。结论单纯超声心动图引导下经皮PDA封堵术安全有效,但应注意根据PDA的解剖特点选择合适的血管途径。     

应用Amplatzer封堵器治疗动脉导管未闭

目的　评价 Amplatzer封堵器在动脉导管未闭 (PDA)介入治疗中的安全性和疗效。　方法　自 2 0 0 0年9月开始应用 Amplatzer封堵器治疗 30例 PDA患者 ,在术后 2 4小时、1个月、3个月行超声心动图检查 ,观察封堵效果及有无并发症。　结果　 PDA最窄处直径为 2 .5～ 12 .0 mm,平均 5 .3mm;1例伴有重度肺动脉高压的粗大 PDA采用 Amplatzer房间隔缺损封堵器治疗 ,余 2 9例用 Am platzer PDA封堵器。2 9例术后 2 4小时、1例 48小时时彩色多普勒超声心动图检查均未见残余分流 ,1例术后早期发生机械性溶血。随访中 ,未出现封堵器移位、残余分流和再通。结论　应用 Amplatzer封堵器治疗 PDA是一种安全有效的非外科手术方法 ,适应证广、技术成功率高、近期疗效满意 ,远期效果尚需进一步观察     

经导管治疗室间隔缺损

目的 评价经导管治疗室间隔缺损(VSD)的疗效及其安全性. 方法 17例VSD患者经胸超声心动图显示,膜部VSD 16例,肌部VSD 1例;合并室间隔瘤1例;2例VSD上缘距离主动脉瓣1mm,其余均在1mm以上;VSD直径2.3～10 mm(5.05±2.03 mm).所有患者均无严重的肺动脉高压或右向左分流.膜部VSD封堵使用Amplatzer膜部室间隔封堵器和国产室间隔封堵器,肌部VSD使用Amplatzer动脉导管封堵器. 结果 17例VSD造影测量值为2.3～10.5mm(5.75±2.10 mm),选择的封堵器直径为4～12 mm(7.12±1.67 mm).17例患者均成功行VSD封堵术,封堵后10分钟造影无残余分流.1例术后即刻出现I度房室传导阻滞伴右束支传导阻滞,无症状;2例术后3～4天出现右束支传导阻滞,全部患者均随访1～12个月,无其它并发症和残余分流发生. 结论经导管治疗VSD是安全有效的治疗方法之一.     

动脉导管未闭封堵术后残余漏二例

我院 1999年收治 2例因动脉导管未闭 (PDA)行 Am-platzer封堵器封堵术后发生残余漏、出现机械性溶血的患者 ,均急诊在体外循环下经肺动脉行动脉导管缝闭术。1　临床资料与方法1.1　一般资料　本组 2例 ,男、女各 1例 ;分别为 35岁和 2 6岁。术前均明确诊断为 PDA,动脉导管直径分别为 2 .0 cm和1.2 cm,均为管形 ,无肺动脉高压。 2例均采用 Amplatzer封堵器治疗 PDA。均于封堵术后 12小时内出现血红蛋白尿 ,胸骨左缘第 2～ 3肋间仍可闻及 ～ 级连续性机器样杂音 ;心脏彩色超声心动图示 PDA封堵处有残余分流 ;血常规示红细胞、血红蛋白…     

Amplatzer封堵器介入治疗先天性心脏病30例

目的评价Amplatzer封堵器进行介入治疗先天性心脏病的近期疗效.方法左向右分流型先天性心脏病30例,经透视或(和)经胸超声心动图(transthoracic echocardiography,TTE)指引下穿刺股动脉或者股静脉,通过导管置入Amplatzer封堵器,分别于术后24 h、1个月、6个月、1年及以后每年通过TTE、心电图和X线胸片检查评价疗效.结果1例膜部室间隔缺损(perimembranous ventricular septal defects,膜部VSD)因选用封堵器直径偏小导致封堵器在释放即刻脱落至主动脉弓部,用抓捕器通过股动脉回收成功,二次置入直径较大的封堵器,封堵成功.其余29例房间隔缺损(atrial septaldefects,ASD)、动脉导管未闭(patent ductus arteriosus,PDA)、膜部VSD均一次置入成功,术中未发生其他并发症.手术时间20～90(38±16)min,X线曝光时间5～45(18±10)min,住院时间3～7(4±2)d.结论Amplatzer封堵器介入治疗先天性心脏病,操作简单、安全、损伤小、成功率高,适合于继发孔型ASD、膜部VSD及各种类型的PDA的介入治疗.     

动脉导管未闭封堵器治疗肾切除术后肾动静脉瘘的疗效观察(附2例报告)

目的观察利用动脉导管未闭(PDA)封堵器治疗肾脏切除术后继发性肾动静脉瘘的疗效及安全性。方法对2例肾脏切除术后继发性肾动静脉瘘的患者用PDA封堵器封堵肾动脉残端,观察临床症状改善程度及肾动静脉形态。结果 2例手术均获得成功,术后肾动静脉瘘被完全隔绝,临床症状迅速改善。术后1个月,CT血管造影及血管彩超检查证实封堵器定位确切,肾静脉管腔显著缩小并且腔内无血栓形成。2例患者的左心室射血分数分别由术前的49%和51%上升到术后的65%和69%。随访时间超过2年,未见并发症。结论对于继发性肾动静脉瘘,利用PDA封堵器单纯对动脉残端进行封堵可以达到理想的治疗效果,具有可靠的安全性。     

介入封堵术治疗先天性心脏病82例

目的总结介入治疗先天性心脏病的临床经验,分析其疗效。方法2006年1月至2008年1月我院共施行介入封堵治疗82例常见先天性心脏病患者,男35例,女47例;年龄5～79岁,平均年龄20.3岁。其中继发孔型房间隔缺损（ASD）39例,缺损直径0.50～2.55cm（1.60±0.55cm）;室间隔缺损（VSD）23例,缺损直径0.30～1.72cm（1.05±0.33cm）;动脉导管未闭（PDA）20例,导管最窄处（腰部）直径0.40～1.10cm（0.80±0.20cm）,均为管型。房间隔缺损封堵术及室间隔缺损封堵术均采用Amplatzer法,动脉导管未闭大部分采用Amplatzer法,仅1例采用Cook可控弹簧栓子法。出院后采用电话、信件、门诊方式进行随访。结果全部患者均无主要并发症发生,无死亡。封堵成功80例,其中房间隔缺损38例,室间隔缺损22例,动脉导管未闭20例。操作时间为55.0±18.5min,住院天数为5.0±2.3d,住院费用为39880±5830元。术后7d、1个月、6个月、1年和2年时随访率分别为97.5%、91.2%、85.0%、73.8%和55.0%。随访5～30个月无残余分流及严重心脏事件。彩色超声心动图提示：封堵器位置良好。结论充分评估病情,严格掌握适应证,经导管介入堵闭治疗先天性心脏病安全、可靠、成功率较高。     

主动脉覆膜支架腔内隔绝术治疗成人巨大动脉导管未闭

目的总结主动脉覆膜支架腔内隔绝术治疗成人巨大动脉导管未闭(PDA)的经验,并对其疗效进行评价。方法回顾性分析2010年9月至2011年8月青海省心脑血管病专科医院8例PDA患者行主动脉覆膜支架腔内隔绝术治疗的临床资料,其中男5例,女3例;年龄(30.4±9.3)岁。主动脉造影显示PDA最窄内径为(21.0±3.0)mm;肺动脉收缩压(76.6±9.4)mm Hg。结果 8例患者中7例一次性隔绝成功。术后即刻血管造影显示6例动脉导管完全封闭,2例残余少量左向右分流。术后2周超声心动图及大血管CT血管造影显示:残余分流消失,肺动脉收缩压(43.5±7.2)mm Hg,显著降低。术后左心室舒张期末内径较术前明显减小[(52.0±5.2)mm vs.(69.0±11.1)mm]。随访8例,随访时间1～11(7.2±1.1)个月,随访期间胸部X线示:肺血明显减少,心胸比率明显减小。结论应用主动脉覆膜支架腔内隔绝术治疗成人巨大PDA是一种安全、有效的方法。     

Amplatzer堵闭器治疗动脉导管未闭的临床应用

目的　评价Amplatzer堵闭器经导管治疗动脉导管未闭 (Patentductusarteriosus,PDA)的效果。　方法　经导管堵闭PDA患儿 15例 ,男 4例 ,女 11例 ,年龄 (1～ 14 )岁 ,体重 (7～ 30 )Kg。　结果　14例成功 ,1例失败。与术前肺动脉压 (6 3 2± 2 3 5mmHg)相比 ,术后即时肺动脉压 (2 0 5± 8 7mmHg)显著下降 (t=9 4 3,P <0 0 0 1)。术后 2 4小时超声心动图 ,1例有少量残余分流 ,随访 1月时超声心动图显示分流消失。全组病例随访 2年 ,无并发症发生。　结论　Amplatzer堵闭器治疗动脉导管未闭是一种安全、微创、疗效肯定的非开胸手术方法。     

胸骨下小切口经心尖封堵小儿动脉导管未闭

目的探讨胸骨下小切口经心尖封堵动脉导管未闭(patent ductus arteriosus,PDA)的疗效。方法回顾性分析2016年7月～2017年5月11例胸骨下小切口经心尖PDA封堵术资料。年龄6. 6～32(17. 0±8. 7)月,体重7. 5～14(9. 4±2. 0) kg,PDA直径3～7(4. 2±1. 2) mm。选择胸骨下剑突区纵向切口1～2 cm,部分暴露右心室表面后,在经食道超声心动图(transesophageal echocardiography,TEE)引导下,血管鞘穿刺右心尖,沿右心室-肺动脉-PDA路径置入PDA封堵器,TEE评估封堵效果。结果术中TEE即刻测量封堵器位置良好,无明显残余分流,11例手术均取得成功。1例术后一过性血小板减少。随访18～28(23. 2±3. 8)月,超声心动显示无残余分流,未见心脏磨蚀,心电图显示无心律失常,心肺功能及生长发育正常。结论胸骨下小切口经心尖封堵PDA具有安全、有效、操作简单等特点,不需锯开胸骨,避免损伤乳腺组织。     

双封堵器介入治疗多孔性房间隔缺损

目的对双封堵器介入治疗多孔性房间隔缺损(ASD)的可行性与有效性进行临床评估。方法对17例多孔性ASD(12例为2孔,5例为3孔)患者在X线透视和超声心动图监测下植入Amplatzer封堵器,同时闭合2～3个缺损。术后复查ECG、X线平片及TTE以评价其疗效。结果 17例术中超声测量ASD大、中和小缺损直径分别为(13.94±3.21)mm、(9.65±2.64)mm及(4.80±1.92)mm。16例获得成功(16/17,94.12%),1例因第2个ASD不适于封堵而放弃,改行外科手术后痊愈出院。16例植入封堵器32枚,共闭合缺损37个,所植入大、小封堵器直径分别为(20.75±4.07)mm和(16.94±3.75)mm,较术中超声所测大孔及中孔ASD径分别增大(7.06±2.65)mm、(7.44±3.25)mm。术后3例残余微或少量分流(2例为3孔ASD),分别于术后第2、3天及3个月复查时消失。1例发生股动静脉瘘,1个月后消失。随访X线胸片测心胸比及超声测右心室前后径均较术前明显下降(P均<0.01)。结论采用双封堵器介入治疗多孔性ASD安全、有效。     

两种封堵器治疗主动脉窦瘤破裂的疗效及安全性

目的探讨应用动脉导管未闭(PDA)封堵器和室间隔缺损(VSD)封堵器治疗主动脉窦瘤破裂的疗效和安全性。方法对19例主动脉窦瘤破裂患者,按所用封堵器分为PDA封堵器组和VSD封堵器组,根据升主动脉造影结果,选择比破口直径大2~5mm的PDA封堵器或VSD封堵器进行经导管介入封堵。术后随访观察临床症状、心电图、残余分流、封堵器形态、有无瓣膜反流等情况。结果两组患者年龄、发病时间和术前TTE所示破口直径、主动脉造影示破口直径差异均无统计学意义(P均0.05)。19例均经升主动脉造影确诊为主动脉窦瘤破裂,其中15例右冠状动脉窦瘤破裂入右心室,3例为右冠状动脉窦瘤破裂入右心房,1例无冠状动脉窦瘤破裂入右心室;共使用PDA封堵器10枚,VSD封堵器11枚,成功率分别为60.00%(6/10)和90.91%(10/11)。术后随访6个月~6年,未发生血栓事件,无瓣膜反流,无心律失常、感染性心内膜炎、心力哀竭及死亡。结论经导管介入治疗主动脉窦瘤破裂安全有效;应用VSD封堵器较PDA封堵器有一定优势。     

Postinfarction ventricular septal defect closure with Amplatzer occluders.

OBJECTIVE: Postinfarction ventricular septal defect (PIVSD) is a rare and life-threatening complication with high risk of both surgical and medical treatment. Another option available now is transcatheter closure. The purpose of this paper is to report the results of such treatment with Amplatzer occluders. METHOD: Seven patients aged from 51 to 71 years were included. The procedure was performed between 2 and 10 weeks after myocardial infarction. One patient had double residual VSD (2 months after previous surgery) and another, coexisting critical stenosis of right coronary artery (RCA). All patients were in III/IV NYHA class, on intropes, one patient on aortic balloon counterpulsation. Venous jugular approach was used to close the VSD in six patients, venous transfemoral in one patient. Implantation of six Ampaltzer atrial septal occluders (ASO) and one muscular Amplatzer VSD occluder (VSO) were performed. RESULTS: All procedures but two were finished successfully. In one patient, the defect could not be entered neither from the venous nor the arterial side due to unusual oblique course (which was confirmed during subsequent operation). In the second patient (2 weeks after MI), the reason was unstable position of 24 mm ASO (probably due to necrotic borders of VSD). Immediate significant clinical improvement was achieved in all patients, in whom PIVSD was closed with Amplatzer occluders. In one postsurgical patient, two ASO were used; in another patient, prior to VSD closure, PTCA and stent implantation to RCA was performed. The stretched diameter of PIVSD ranged from 8 to 22 mm, the size of implanted Amplatzer occluders from 12 to 24 mm. Fluoroscopy time was 60 min (18-120). During the procedure, ventricular fibrillation requiring defibrillation was observed in three patients. One patient died 1 week after the procedure because of multiorgan failure and increasing mitral incompetence (MI). CONCLUSIONS: Despite some technical problems, implantation of Amplatzer occluders, is an attractive option of treatment of patients with subacute PIVSD.     

Erosion of an Amplatzer septal occluder device into the aortic root

Atrial septal defects can be closed surgically or percutaneously. We report a patient who underwent percutaneous closure of an atrial septal defect with an Amplatzer septal occluder device (AGA Medical Corp, Golden Valley, MN). The patient presented 4 months later with congestive heart failure secondary to an erosion of the Amplatzer septal occluder into the aortic root. The device was removed surgically, and the fistula was repaired. Amplatzer septal occluder indications, selection criteria, and complications are discussed.     

Embolization of pancreatic allograft arteriovenous fistula with the Amplatzer Vascular Plug 4: case report and literature analysis

Vascular complications remain a major cause of graft loss after pancreatic transplantation. They include vascular thrombosis, pseudoaneurysm, and arteriovenous fistula (AVF). We report a case of an AVF that appeared 3 months after a simultaneous pancreas-kidney transplantation (SPKT). Doppler ultrasonography followed by magnetic resonance angiography and later angiography provided a definitive diagnosis of a mesenteric AVF. An endovascular approach is becoming the treatment of choice owing to the high risk of graft loss associated with open surgical correction. Microcoils alone, or in conjunction with detachable balloons, are frequently used; still, a new generation of vascular plugs seem to offer a therapeutic option for AVF closure, because it is a “1 shot” procedure that avoids the risk of accidental coil migration. A new-generation Amplatzer Vascular Plug 4 was deployed over the distal arterial branch of the superior mesenteric artery stump, leading to complete exclusion of the AVF and restoring normal vascular flow.     

Surgical revision of an uncommonly dislocated self-expanding Amplatzer septal occluder device

Open heart surgery is the standard procedure for closure of ostium secundum atrial septal defects. Recently, percutaneous transcatheter procedures emerged as therapeutic alternatives for closure of both atrial septal defects and patent foramen ovale. Unfortunately, however, such percutaneous procedures may require surgical intervention for early or late complications. We report a case with emergent surgery for dislocation of the Amplatzer septal occluder into the aortic arch diagnosed 30 days after percutaneous closure of an atrial septal defect.     

Use of Amplatzer septal occluder system for atrial septal defect closure

Short-term results of minimally invasive transcatheter closure of atrial septal defect using Amplatzer septal occluder system (AGA Medical Corporation, USA) at 72 patients are analyzed. Technique of surgical procedure is described in detail. Morphometric protocol used for determination of indications and contraindication for endoscopic closure is also described. The causes of impossibility of endovascular procedures are established. The rate of transoccluder blood bypasses in postoperative period is demonstrated.     

TEE在外科微创房、室间隔缺损封堵术中的应用

目的探讨TEE引导下外科微创封堵治疗房间隔缺损(ASD)、室间隔缺损(VSD)的价值。方法 58例ASD和129例VSD患者接受TEE引导下外科微创封堵治疗。术中行胸壁小切口暴露心脏,于TEE监测下选择右心房或右心室穿刺点,指引动脉止血鞘通过缺口后释放封堵装置,待TEE多切面证实封堵器位置良好、无明显残余分流及瓣膜并发症后释放封堵器。结果 58例ASD均封堵成功,术后即刻TEE见8例封堵器周围微量残余分流。129例VSD中,114例VSD封堵成功,其中19例术后即刻TEE检查见残余分流,2例右心室流出道血流速度增快,1例变更右心室壁穿刺点后导丝顺利进入缺口;15例转行体外循环下心内直视修补术。结论 TEE可用于指导外科微创封堵治疗ASD和VSD,包括测量缺损大小和位置、选择封堵器型号、确定手术路径、引导封堵器释放和评估治疗效果。     

Embolization of an Amplatzer atrial septal closure device to the pulmonary artery

A 44-year-old woman with a history of transient ischemic attack underwent closure of atrial septal defect with a 26 mm Amplatzer device. The device was released without residual shunt or impingement on intracardiac structures. Within seconds, the transesophageal echocardiography showed the initial dislodgement of the device from the atrial septum and its consequent slipping back into the right atrium close to the tricuspid valve. Soon after the device disappeared from the right atrium and it could be founded into the right ventricle under the tricuspid valve. The patient was transferred in the operating room for an emergency operation. The device could not be found in the right ventricle because its downstream migration. The Amplatzer septal occluder was identified by palpation into the pulmonary artery trunk: it was retrieved from the right ventricle through the pulmonary valve and the atrial septal defect was closed by running suture.