双Amplatzer封堵器封堵多发房间隔缺损一例

患者女 ,12岁 ,2 0 0 1年 7月住院。 6年前因感冒发现心脏杂音。检查 :胸廓畸形 ,胸骨左缘 2、3肋间闻及Ⅱ级柔和收缩期杂音 ,肺动脉瓣区第二音增强 ,固定性分裂。心脏Doppler超声检查 :剑突下四腔切面见两个房间隔缺损孔 ,直径分别为 16mm和 10mm ;两孔间距离为 10mm。缺损孔距上腔静脉 5mm ;距下腔静脉 11mm ;距肺静脉 4mm ;距主动脉根部 6mm ;距二尖瓣瓣环 6mm ,房间隔直径 4 6mm。诊断 :多发孔房间隔缺损 (ASD)。患者行经导管ASD堵闭术治疗。静脉麻醉下常规左右股静脉置入鞘管 ,经两个ASD孔分别送长交换导丝达左右肺上静脉。用球囊…     

Amplatzer封堵器关闭房间隔缺损2例

例 1 　 女 ,4.5岁。体重 1 5kg,身高 1 0 5cm。体检发现有心脏杂音 1年余。入院体检 :生长发育略差 ,无青紫 ,L2～ 3 可闻及 ～ /6级收缩期杂音 ,S2固定分裂 ;X线胸片示无异常 ,心∶胸 =0 .48;心电图示右心室肥厚 ,经胸超声 ( TTE)提示 孔型房间隔缺损 ( ASD)约 1 .1 cm,肺静脉均入左房。例 2 　 女 ,5岁。体重 1 9kg,身高 1 1 5cm。因心慌 ,体检发现有心脏杂音就诊。体检 :生长发育正常 ,无青紫 ,S2 固定分裂 ,L2 可闻及 级收缩期杂音 ;X线胸片示心影大 ,肺动脉段平直 ,心∶胸 =0 .55;心电图示窦性心律 ,T波双向或低平 ;TTE提…     

大型Amplatzer间隔封堵器脱落后介入取出及房间隔缺损再封堵成功一例

患者男性,32岁.因胸闷、气短半个月入院.胸骨左缘第2肋间闻及3/6级收缩期杂音.超声心动图示右心房、右心室(47 mm)扩大,房间隔中部连续中断32 mm,左心室缩小(37 mm),三尖瓣中度反流,肺动脉收缩压51 mm Hg(1 mm Hg=0.133 kPa).     

Amplatzer封堵器在经皮房间隔缺损封堵中的作用

近来Ａｍｐｌａｔｚｅｒ封堵器封堵房间隔缺损取得长足进展,本文介绍Ａｍｐｌａｔｚｅｒ封堵器的结构、封堵的机理、适应证和禁忌证、手术操作、临床研究及优缺点等内容。     

Amplatzer封堵器封堵较大室间隔缺损一例

患儿男,3岁,体重14 kg,以发现心脏杂音2年入院.查体:精神反应尚可.双肺呼吸音粗,未闻及干湿啰音.心前区饱满,心音有力,律齐.胸骨左缘3、4肋间可闻及3/4级粗糙收缩期杂音,可触及震颤.肺动脉瓣第二音无明显亢进.胸部X线片示:双肺纹理增多,心影增大.     

房间隔缺损术后再通经导管封堵一例

患者女性 ,39岁 ,先天性房间隔缺损 (房缺 )修补术后 10年 ,发作性心悸 2年入院。患者于 15岁时体检发现“房缺” ,当时无特殊不适。 1989年在外院行心脏直视下房缺修补术 ,手术过程不详。术后 3个月复查心脏超声 ,发现房间隔修补处撕裂 ,房缺修补术后再通 ,未做进一步处理。 1997年 3月起 ,无明确诱因反复出现心悸、胸闷 ,多次心电图检查示心房扑动 ,呈 1∶1或 2∶1传导 ,可自行转复为窦性心律。此次因拟行房缺经导管封堵术而入院。查体 :体温 36 4℃ ,脉搏72次 /ｍｉｎ ,血压 10 5 / 70ｍｍＨｇ (1ｍｍＨｇ=0 133ｋＰａ)。神志清楚 ,自…     

应用Amplatzer封堵器封堵小儿房间隔缺损的并发症分析

目的总结Amplatzer封堵器(ASO)封堵小儿房间隔缺损(ASD)出现的并发症种类、防治经验和教训。方法应用Amplatzer封堵的289例ASD，9例在术中或术后随访中出现并发症：体循环系统空气栓塞2例、肺空气栓塞1例、心包填塞1例、封堵器脱落1例、房性早搏1例、测量球囊碎片残留体内1例、封堵器部分移位1例、二尖瓣穿孔并返流1例。对上述9例分别给予内科、外科积极治疗及随诊观察等处理。结果冠脉气栓及早搏病例自行缓解。封堵器部分移位及二尖瓣穿孔病例仍在随访观察中，其余病例均经治疗痊愈。结论空气栓塞是应用ASO治疗较易发生的并发症，而并发症的发生多数与手术操作有关。并发症一旦发生应采取包括外科手术在内的积极处理。加强对ASO治疗病例的随访工作非常重要。     

经皮双圈套器回收脱落的Amplatzer房间隔缺损封堵器一例

患者男性,32岁,2007年12月3日以"活动后胸闷气促半个月,咳嗽、咯痰3 d"入院.心电图提示窦性心律,完全性右束支传导阻滞.     

应用Amplatzer封堵器封堵小儿房间隔缺损的并发症分析

目的　总结Amplatzer封堵器 (ASO)封堵小儿房间隔缺损 (ASD)后出现并发症的种类及其防治方法。方法　应用Amplatzer封堵器封堵的 2 11例ASD患儿中 ,9例在术中或术后随访中出现并发症。其中体循环系统空气栓塞 2例、肺空气栓塞 1例、心包填塞 1例、封堵器脱落 1例、房性早搏1例、测量球囊碎片残留体内 1例、封堵器部分移位 1例、二尖瓣穿孔并返流 1例。分别给予内科、外科积极治疗及随诊观察等处理。结果　冠状动脉气栓及早搏病例自行缓解。封堵器部分移位及二尖瓣穿孔病例仍在随访观察中 ,其余病例均经治疗痊愈。结论　空气栓塞是应用ASO治疗时较易发生的并发症 ,且其发生多数与手术操作有关。并发症一旦发生大多需采取包括外科手术在内的积极处理。加强对ASO治疗病例的随访工作非常重要。     

应用Amplatzer封堵器治疗房间隔缺损

目的 :应用 Amplatzer封堵器治疗继发孔型房间隔缺损并对其疗效进行初步评价。方法 :全组共 6例 ,年龄38± 13岁 （2 0～ 5 5岁 ）。在透视及食管超声心动图监视下经导管置入 Am platzer封堵器封堵房间隔缺损。术后即时行食管超声心动图 ,术后 2 4h、1月、3月分别行经胸超声心动图评价治疗效果。结果 :全组疗效均佳 ,未见残余分流。结论 :应用 Am platzer封堵器治疗继发孔型房间隔缺损是有效的非手术方法 ,操作简便 ,成功率高 ,近期疗效可靠     

Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders

OBJECTIVES: The aim of this study was to assess long-term results of percutaneous closure of secundum-type atrial septal defect (ASD II) using Amplatzer septal occluders (ASO). BACKGROUND: Only immediate-, short-, and intermediate-term results of ASO implantation are known so far. METHODS: Between September 1995 and January 2000, 151 patients underwent a successful percutaneous closure of ASD II in our institution. All were included in the present study and were followed up until September 2004. RESULTS: This group of patients was followed up from 56 to 108 months (median 78 months). The mean stretched defect diameter was 15.9 +/- 4.8 mm. There were no deaths or significant complications during the study. At three years of follow-up, all defects were completely closed and remained closed thereafter. CONCLUSIONS: Since the first human implantations in September 1995, the Amplatzer septal occluder proved as a safe and effective device for percutaneous closure of ASD II.     

Percutaneous transcatheter ventricular septal defect closure in adults with Amplatzer septal occluders

BACKGROUND: The interest in transcatheter ventricular septal defect (VSD) closure is continuously growing. Therefore, we report our experience in perimembranous (Pm) and postinfarction (Pi) VSD closure. METHODS: All patients, older than 16 years, were selected from a data base, in which Pm and Pi VSDs were registered.The patients' files were reviewed until the most recent follow-up date. RESULTS: Nine (7 male, 37.4 +/- 12.8 y) and 8 (6 male, 76.3 +/- 6.2 y) patients underwent a Pm (group A) and Pi VSD (group B) closure, respectively. One female patient was treated for a posttraumatic VSD (26 y). In group A, 7 patients were closed with the Amplatzer perimembranous VSD occluder, one with the muscular VSD occluder, and one patient with the atrial septal defect occluder. All patients in group B were treated with the muscular VSD occluder. In the post-traumatic VSD an Amplatzer patent foramen ovale occluder was used. Device implantation was feasible in all, except in two patients with extremely large VSDs (one Pm and one PiVSD). Total transcatheter closure or small residual leakage was achieved in 7/8 patients in group A, but one patient needed surgical VSD repair because of massive haemolysis, another patient died 9 months later. A small or moderate shunt was present immediately after the procedure in all patients of group B. No device-related complications were reported, but all, except one patient, died within 2 weeks after the procedure because of an extremely high co-morbidity (logistic Euroscore 70 +/- 25%).Total closure was achieved in the post-traumatic VSD. CONCLUSION: Transcatheter closure of Pm and Pi VSD with Amplatzer septal occluders in adults is feasible and safe, but the post-procedural prognosis totally depends on the aetiology of the VSD and its co-morbidity.     

应用Amplazter封堵器治疗膜周部室间隔缺损的进展

膜周部室间隔缺损（室缺）是最常见的先天性心脏病。自从本世纪初Amplatzer膜周型封堵器被广泛应用于膜周部室缺介入封堵治疗。同时新型改良设计的Amplatzer封堵器陆续问世,以及多种Amplazter封堵器非常规应用于膜周部室缺封堵,并开展了大量的临床应用研究。目前由于应用初代Amplatzer膜周型封堵器后近期或远期完全性房室传导阻滞并发症发生率较高,许多中心放弃了对其继续研究应用。对于完全性房室阻滞的机制深入探究以及封堵器选择应用进一步优化,将使Amplatzer封堵器在临床中具有广泛的应用空间,并为膜周部室缺的介入封堵治疗提供了新的思路。     

Efficacy of ticlopidine for preventing migraine after transcatheter closure of atrial septal defect with Amplatzer septal occluder: a case report

Transcatheter closure of an atrial septal defect using the Amplatzer septal occluder is a current treatment option in Japan, but is occasionally associated with transient exacerbation or new onset migraine. Clopidogrel is effective in such a situation, but the efficacy of ticlopidine, an analog of clopidogrel, on migraine remains unclear. A 15-year-old girl presented with typical migraine attacks with aura 11 days after transcatheter closure of an atrial septal defect with an Amplatzer septal occluder. All examinations excluded thromboembolic origin of the migrain. Her symptoms disappeared completely after medication with ticlopidine.     

Echocardiographic predictors of candidacy for successful transcatheter atrial septal defect closure

We reviewed pre-closure echocardiograms on all patients undergoing transcatheter atrial septal defect (ASD) closure with the Bard double-umbrella occluder device aided by simultaneous transesophageal echocardiography to determine precatheterization predictors of outcome. Transesophageal echocardiograms were performed on 28 of 132 patients (22%) undergoing device closure (age = 3–72 years, mean = 14 years; weight = 15–68 kg, mean = 35 kg). Three devices were removed because of unstable position. Of the remaining 25 patients, 21 had effective closure (residual flow diameter ≤ 3 mm) and 18 had favorable arm position (device arm on proper side of the septum and not in contact with an atrioventricular valve leaflet). Only ASD size predicted effective closure. All patients with a maximum defect size of < 13 mm had effective closure. Among the 17 patients with defects ≥ 13 mm, 10 had effective closure, 4 had significant residual flow, and 3 had devices removed for unstable position. Atrial dimensions and rim size did not predict effective closure. There were no pre-closure predictors of favorable arm position which was associated only with the size of the device implanted.     

超声心动图在Amplatzer封堵器经导管治疗房间隔缺损中的价值

目的　超声心动图引导Amplatzer封堵器经导管关闭房间隔缺损 (ASD)。方法　 15例待外科手术的ASD患者 ,超声检查 [12例经食管超声心动图 (TEE)检查、3例经胸超声心动图 (TTE)检查 ]符合条件而准备行经导管ASD封堵术。在超声及X线引导下 ,以ASD最大伸展径或加 1～ 2mm为标准 ,选择Amplatzer封堵器型号 ,导管送封堵器到ASD处、释放 ,腰部卡于ASD口处 ,两伞贴于房间隔两侧。结果　 2例患者ASD最大伸展径 >34mm ,没有相应大的封堵器而放弃封堵术 ,其余 13例成功地进行了ASD封堵。超声测量ASD径非常显著小于ASD最大伸展径 [(16 92± 5 35 )mm∶(2 1 38±5 0 1)mm ,P <0 0 1],平均相差 4 46mm。术后立即、2 4h、1个月及 3个月行TTE检查 ,13例患者封堵器位置准确、稳定 ,均无残余分流。所有患者术中及术后均无并发症。结论　用Amplatzer封堵器关闭ASD ,超声在病例的选择、引导封堵器置入及术后疗效观察等方面有极重要、不可替代的作用。