Special comment ASD ASD. (atrial septal defect, ASD) ASD ASD ASD 87% 3

Transcription

1 J Intervent Radiol 2011 Vol.20 No.1 3 Special comment : ( ) 7 ~ 8 (ASD) 10% ASD ASD ASD ; ; ; :R541.1 :A : X(2011) Interventional treatment of common congenital heart diseases: the common view of Chinese medical experts. Part one: Interventional treatment of atrial septal defect Committee on Congenital Heart Diseases Internal Medicine Branch of Cadiovascular Diseases Chinese Physicians Association Corresponding author: ZHU Xian-yang Abstract Atrial septal defect (ASD) a congenital heart disease more commonly recognized in female adults accounts for 10% of all congenital heart diseases. Echocardiographic study can accurately provide the precise information about the size and location of the defect in detail. Most ASDs can be cured by transcatheter device closure. In this chapter the indications contraindications procedures and device sizing for ASDs of interventional management will be systemically described meanwhile the complications caused by device occlusion and their preventions will also be discussed. The treatment for ASD patients accompanied with pulmonary arterial hypertension multiple-orifice defects aneurysmatic defects or defects with poor edge will be involved in this chapter. (J Intervent Radiol : 3-9) Key words congenital heart disease; interventional therapy; atrial septal defect; complication (atrial septal defect ASD) ASD ASD 60% ~ 70% ; ASD 15% ~ 20% 10% 20% ~ 30% ~ 3 ASD : : xyangz@yahoo.com.cn ASD 87% 3 3 mm ASD 1 100%

2 J Intervent Radiol 2011 Vol.20 No.1 ; 3 ~ 8 mm 1 80% 1.3 ; 8 mm ASD ASD ASD 7 ~ % % ASD ASD 20 ~ ASD ( ) Murphy 2 24 Amplatzer Cardioseal Gore Helix 40 Star FLEX [3-4] ASD ASD Amplatzer AGA Amplatzer 10 mm 3 ASD - ASD Amplatzer ~ 40 mm ASD 2 mm 12 ~ 14 mm 10 ~ 1 12 mm [1] 1.1 ASD ASD 5 mm ASD 36 mm ASD mm; ASD [2] < (TTE)() ASD (TEE) mm ASD ASD ASD : QP / QS % / X TTE TTE 3 ;2

3 J Intervent Radiol 2011 Vol.20 No.1 5 ASD ASD ;3 8 ~ 10 mm ASD TEE TTE ASD X ~ ~ 30 X ~ 6 h ; Y ; ASD ; u / kg 1 h 1 / 4 ~ 1 / ~ 6 h 20 h; 3 d ASD h 100 u / (kg cm d)4 100 u / kg ASD ~ 5 mg kg -1 (1 4) X ; 12 1 d -1 6 ; 30 mm ASD 75 mg / d h X X ASD 4 ASD ASD 4.1 ASD ASD ASD QP / QS 1.5 ASD 75% Steele ASD 15 U m 2 1 ~ 2 mm TTE ASD 4 ~ 6 mm 2 ~ 4 mm

4 J Intervent Radiol 2011 Vol.20 No ASD 20% SaO 2 94% Lezo [5] 29 [ (56 ± 14)]ASD > 40 mmhg (65 ± 23)mmHgQp / Qs 1.8 ± 0.5 ASD (21 ± 14) TEE (31 ± 11)mmHg ASD ASD 4.4 ASD Qp / Qs 1.3 ASD ASD ; 5 mm SaO 2 SaO ASD 3 ~ 6 Y ASD [6-8] 4.5 ASD ASD ASD 4.2 ASD TTE ASD TEE 2 ASD 7 mm TEE ; > 7 mm 1 2 ~ ASD ; 35 mm 2 ~ 3 ASD ASD % ~ % ASD ASD 5 ASD

5 J Intervent Radiol 2011 Vol.20 No.1 7 ASD 100% ; 3 ST 20 ~ 30 min ASD 98.04% 1.89% [9] < 1 mm ~ 2 mm Amplatzer 6% ~ 40% 72 h 4% ~ 12%3 0.1% ASD [10] ; mm 1 ; 5 mm ASD % 0.12%

6 J Intervent Radiol 2011 Vol.20 No.1 ASD 2 [14] 6.9 ; ASD 0.06% ; % ~ 1.44% [11] 6.10 ASD ; ASD [15] 6.11 ASD ( ) ( ) 42: [ ] [1]. [J] [2]. [J] : [12-13] [3] Jones TK Latson LA Zahn E et al. Results of the U.S. multicenter pivotal study of the HELEX septal occluder for ASD percautaneous closure of secundum atrial septal defects [J]. J Am Coll Cardiol : ASD [4] Jux C Bertram H Wohlsein P et al. Interventional atrial septal defect closure using a totally bioresorbable occluder matrix: development and preclinical evaluation of the BioSTAR device [J]. J Am Coll Cardiol : [5] de Lezo JS Medina A Romero M et al. Effectiveness of percutaneous device occlusion for atrial septal defect in adult patients with pulmonary hypertension [J]. 144: Am Heart J 2002 [6] Holzer R Cao QL Hijazi ZM et al. Closure of a moderately large atrial septal defect with a self-fabricated fenestrated

7 J Intervent Radiol 2011 Vol.20 No.1 9 Ampatzer septal occluder in an 85-year-old patient with reduced diastolic elasticity of the left ventricle [J]. Cath Cardiovasc Interv : [7] Patel A Lopez K Banerjee A et al. Transcatheter closure of atrial septal defects in adults > or = 40 years of age: immediate and follow-up results[j]. J Interv Cardiol : [8] Elshershari H Cao Q-L Hijazi ZM. Transcatheter device closure of atrial septal defects in patients older than 60 years of age: immediate and follow-up results [J]. J Invasive Cardiol : [9]. [J]. cardiovascular medicine. Incomplete endothelialization and late : development of acute bacterial endocarditis after implantation of [10] Chessa M Carminati M Butera G et al. Early and late an Amplatzer septal occluder device [J]. Circulation 2008 complications associated with transcatheter occlusion of 117: e326 - e327. secundum atrial septal defect[j]. J Am Coll Cardiol : [11] Bartel T Bonatti JO Müller S. Device dislocation probably due to paroxysmal coughing early after percutaneous closure of secundum type atrial septal defect [J]. Am J Cardiol : [12] Oliver JM Gallego P Gonzalez A et al.predisposing conditions for atrial fibrillation in atrial septal defect with and without operative closure[j]. Am J Cardiol : [13] Hessling G Hyca S Brockmeier K et al. Cardiac dysrhythmias in pediatric patients before and 1 year after transcatheter closure of atrial septal defects using the amplatzer septal occluder [J]. Pediatr Cardiol : [14] Chun DS Turrentine MW Moustapha A et al. Development of aorta-to-right atrial fistula following closure of secundum atrial septal defect using the Amplatzer septal occluder [J]. Catheter Cardiovasc Interv : [15] Slesnick TC Nugent AW Fraser CD Jr et al. Images in ( : ) ( ):!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 2011 (2011CCIO) : ; MR MR PET-CT MR ; ; TACE TACE (F1) / 400 F1 / : : ( ) ( ); ( ); : 37 : liufang@cyberzone.cn