经胸微创房间隔缺损封堵术临床分析

Minimally invasive occlusion via thorax for atrial septal defect

摘要:

目的：分析经胸微创房间隔缺损（Atrial septal defect，ASD）封堵术的疗效。方法：全组63例，年龄（32.47±17.66）岁，ASD最大径（26.22±9.75） mm，心功能（纽约心脏协会分级）Ⅰ级23例、Ⅱ级32例、Ⅲ级8例，重度肺动脉高压9例。全麻下经右胸第4肋间胸骨旁小切口，经胸超声引导下经输送器置入封堵器。结果：成功封堵61例，术后（6.09±2.58） d出院，封堵器型号（33.88±10.51） mm，比ASD最大径大（7.97±2.27） mm。随访3～51个月，无残余漏，心功能改善，无栓塞。因封堵不成功，1例中转体外循环下修补，1例中止手术。结论：经胸ASD封堵术治疗继发孔ASD微创、安全。

Abstract:

Objective：To analyze the clinical efficacy of minimally invasive occlusion via thorax in the treatment of atrial septal defect （ASD）. Methods：Clinical data of 63 patients with ASD were analyzed. The age of the patients was （32.47±17.66） years old and the maximum diameter of ASD was （26.22±9.75） mm. Heart function grading according to New York Heart Association（NYHA）：23 patients in class Ⅰ， 32 patients in classⅡ， 8 patients in class Ⅲ. There were 9 patients with severe pulmonary hypertention. All pa－tients were under general anaesthesia and a small incision was made in the 4th intercostal of the right sternum. The occluder was re－leased using monotubed unit，with the help of normal transchest echocardiography. Results：The procedure was successfully completed in 61 patients.The diameter of the occluder was （33.88±10.51） mm，（7.97±2.27） mm larger than the maximum diameter of ASD. The patients were discharged at （6.09±2.58） d postoperatively. No atrial shut or embolism was found within 3-51 months after the operation.The heart function was improved in all patients. One patient was converted to surgery under cardiopulmonary bypass and one patient discontinued the operation due to the failure in the occlusion. Conclusion：ASD occlusion via thorax is minimally invasive and safe.