【摘要】：目的:評價超聲心動圖引導下采用國產(chǎn)器材在封堵房間隔缺損(atrial septal defect,ASD)時心導管法及經(jīng)胸小切口法兩種介入術(shù)式的安全性。方法:回顧性分析成功采用國產(chǎn)器材封堵ASD共1 080例,其中心導管法734例,經(jīng)胸小切口法346例。心導管法術(shù)中是在導管室用大型數(shù)字減影血管造影機引導下,并結(jié)合經(jīng)胸超聲心動圖(transthoracic echocardiography,TTE)監(jiān)測整個封堵過程,以TTE評價療效。經(jīng)胸小切口法在手術(shù)室完全使用經(jīng)食管超聲心動圖(transesophageal echocardiography,TEE)引導整個封堵過程,指導放置封堵器,并即刻評價療效。結(jié)果:兩種介入術(shù)式中用國產(chǎn)器材封堵ASD均能取得滿意療效,兩種介入術(shù)式比較,缺損最長徑大小差異無統(tǒng)計學意義(P0.05),ASD/房間隔長度、封堵器大小、封堵器大小與ASD最長徑的差值差異均有統(tǒng)計學意義(均P0.05)。當ASD算術(shù)平均數(shù)30 mm時,兩種介入術(shù)式封堵成功率均為100%;當ASD算術(shù)平均數(shù)≥30 mm時,經(jīng)胸小切口法封堵成功率為100%,心導管法封堵成功率為50%。結(jié)論:國產(chǎn)器材封堵安全,成本低。對于同樣大小的缺損,經(jīng)胸小切口法選擇的封堵器較小,更合適。當ASD算術(shù)平均數(shù)≥30 mm時,經(jīng)胸小切口法成功率比心導管法大,心導管法失敗者可轉(zhuǎn)為經(jīng)胸小切口法。
[Abstract]:Objective: to evaluate the safety of cardiac catheterization and transthoracic small incision during transcatheter closure of atrial septal defect (atrial septal defect,ASD) under echocardiographic guidance. Methods: 1 080 cases of ASD were successfully occluded with domestic equipment, including 734 cases with cardiac catheterization and 346 cases with transthoracic small incision. Under the guidance of large digital subtraction angiography machine and transthoracic echocardiography (transthoracic echocardiography,TTE), the whole occlusion process was monitored in cardiac catheterization. TTE was used to evaluate the effect of cardiac catheterization. Transthoracic transesophageal echocardiography (transesophageal echocardiography,TEE) was used to guide the whole occlusion process, to guide the placement of occluder, and to evaluate the curative effect immediately. Results: the ASD was occluded with domestic equipment in two interventional procedures. There was no significant difference in the longest diameter of defect between the two interventional procedures (P0.05), the atrial septal length of ASD/, the size of occluder, and the size of occluder were not significantly different between the two interventional procedures (P0.05). The difference between the size of occluder and the longest diameter of ASD was statistically significant (P0.05). When ASD arithmetic average was 30 mm, the success rate of two interventional procedures was 100, when ASD arithmetic average was more than 30 mm, the success rate of transthoracic small incision occlusion was 100 and that of cardiac catheterization was 50. Conclusion: domestic equipment is safe and low cost. For the same size defect, the transthoracic small incision occluder is smaller and more suitable. When the arithmetic average of ASD was more than 30 mm, the success rate of transthoracic small incision was higher than that of cardiac catheterization, and the failure of cardiac catheterization could be converted to transthoracic small incision.
【作者單位】： 河北醫(yī)科大學第一醫(yī)院心臟超聲科;香港大學深圳醫(yī)院心血管內(nèi)科;河北醫(yī)科大學第一醫(yī)院心血管外科;河北醫(yī)科大學第一醫(yī)院心血管內(nèi)科;
【基金】：河北省醫(yī)學科學研究重點課題(ZL20140061)~~
【分類號】：R540.45;R541.1

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