摘要目的 探讨房间隔缺损(ASD)介入治疗封堵器选择的影响因素.方法 1114例ASD患者,男388例,女726例,年龄2～75(26.3±17.0)岁.按14岁作为儿童与成人的划分点,成人组779例,平均年龄(34.4±13.5)岁;儿童组335例,平均年龄(7.3±3.9)岁.经胸超声心动图测量不同切面缺损大小及边缘长短,根据ASD最大直径选择封堵器,分析不同年龄、缺损形态和边缘大小时,选择封堵器的差别.结果 1114例ASD患者,成功封堵1085例,技术成功率为97.4%.1085例患者中,ASD最大直径为(19.7±7.8)mm,所选择的封堵器直径为(25.8±8.9)mm,封堵器与ASD最大直径差值为(6.1±3.4)mm,封堵器/最大直径为1.3∶1.成人和儿童组ASD大小相近,但成人组封堵器直径、封堵器加大值明显大于儿童组(P<0.05);封堵器/ASD最大直径成人组为1.2～1.8∶1,儿童组为1.1～1.6∶1.随着缺损直径的增大,成人组选择封堵器的加大值亦增加,但非成比例增加.儿童组随着缺损直径的增大,选择封堵器的加大值有增大的趋势,但差异无统计学意义.ASD的最大直径与封堵器的大小显著相关,成人和儿章组其相关系数分别为0.911和0.944(均P<0.01).以ASD最小直径/ASD最大直径的比例来描述缺损的形态,发现随着最小直径与最大直径比值的增大,各组间ASD最大直径或封堵器直径虽无差异,但封堵器加大值明显增大.主动脉侧无缘组选择的封堵器、封堵器加大值明显大于有缘组(均P<0.01).结论 介入治疗ASD,封堵器选择应以测量的ASD最大直径为主体,尚需参考年龄、缺损的形态及其边缘的状况适当增减.

abstractsObjective To analyze factors influencing the choice of atrial septal occluder (ASO) for transcatheter closure of patients with secundum atrial septal defect (ASD). Methods A total of 1114 ASD patients [388 males, aged from 2 to 75 years, mean age (26.3±17.0) years] were enrolled. Patients were divided to adult (>14 years, mean 34.4 years, n=779 ) and child (≤14 years, mean 7.3 years, n= 335) groups. ASD size in different ultrasound cross-sections was determined by transthoracic echocardiography (TTE). ASO size was chosen on the basis of the maximum diameter of the defect (MD). Defect-shapes and rim lengths of ASD, the difference choice of ASO in the two groups were compared. Results MD of the defects ranged from 5 to 40 mm [mean (19.7±7.8) mm]. ASD was successfully occluded in 1085 out of 1114 patients (97.4%). Occluder size ranged from 6 to 46 nun[mean (25.8±8.9) mm] and the difference between occluder size and MD ranged from 2 to 10 mm [mean (6.1± 3.4) mm, ASO/MD ratio 1.3:1]. Though the diameter of the defect was similar between the 2 groups, the size of occluder was significantly larger in adult group than that in child group (ASO/MD ratio 1.1-1.6:1 vs. 1.2-1.8:1, P<0.05). MD was significantly correlated with ASO in both groups (r=0.911 and r=0.944 in adults and child groups, respectively, all P<0.01). The size and increment of the occluder used in patients with deficient anterior rims was significantly bigger than patients with sufficient anterior rims (P<0.01). Conclusion The maximum diameter of the defect was the major determinant for selecting oecluder size and choice of occluder size was also influenced by patient age, defect-shape and defect rim for transcatheter closure of secundum ASD.