Table of Contents

HK J Paediatr (New Series)
Vol 10. No. 4, 2005

HK J Paediatr (New Series) 2005;10:251-256

Original Article

Midterm Outcomes of Transcatheter Closure of Atrial Septal Defect Using the Amplatzer Septal Occluder in Children
經心導管手術方法使用 Amplatzer 房間隔(ASD)閉合器治療兒童房間隔缺損的中期研究報告

AKT Chau, BHY Chung, KS Lun, YF Cheung, TC Yung


Abstract

Purpose: This study reports the clinical experience and midterm outcomes of transcatheter closure of secundum atrial septal defect with the Amplatzer septal occluder in children. Methods: From April 1998 to June 2002, 41 children (male = 14) with a median age of 11.0 years (range = 3.2-18.9 years) and median weight of 31.5 kg (range = 13.5-65 kg) underwent transcatheter closure of secundum atrial septal defect using the Amplatzer Septal Occluder after a detailed pre-implantation evaluation. The procedures were performed under general anaesthesia with fluoroscopic guidance and transesophageal echocardiographic monitoring. The size of the device deployed was determined by the balloon-stretched diameter of the defect. Patients were followed for any residual shunts and possible complications. Results: The mean diameter of atrial septal defect measured by transesophageal echocardiography was 14.3±4.1 mm and 19.2±4.7 mm by balloon-stretched diameter. The mean device diameter was 19.2±4.7 mm (range = 11-30 mm). The mean fluoroscopy time was 17.3 minutes (range = 7.4 to 30 minutes) and the mean procedure time was 100 minutes (range = 35-190 minutes). All devices were successfully deployed. Two patients developed transient atrioventricular dissociation with spontaneous recovery. Complete closure rate at 24 hours, one week, one, 6 and 12 months were 83% [90% confidence limit (CL): 73-91%], 93% (90% CL: 84-97%), 95% (90% CL: 81-96%) and 97% (90% CL: 91-99%), respectively. The mean follow-up period was 46.5?8.6 months (range = 10.7-86.6 months). All devices were in stable position with no late complications. Conclusions: Transcatheter closure of atrial septal defect using the Amplatzer Septal Occluder is safe and effective in children. The midterm results are excellent. However, long-term follow-up is needed to ascertain the absence of possible late complications.

目的:本研究總結了經心導管手術方法,使用 Amplatzer ASD 閉合器治療兒童繼發孔 ASD 損的臨床經驗及治療結果的中期報告。方法:本研究包括了 1998 年 4 月至 2002 年 6 月期間,在本院治療的 41 例兒童(男:14 例,女:27 例),平均年齡 11.0 歲(範圍 3.2 歲至 18.9 歲),平均體重 31.5 公斤(範圍 13.5-65 公斤)。所有病兒先進行詳細的術前評估,而後經心導管手術方法,置入 Amplatzer ASD 閉合器治療繼發孔 ASD。所有手術都是在全身麻醉後,以 X-光及食道超聲波指引下進行的。根據球囊測量方法選擇閉合器。隨訪時主要對殘餘漏孔及併發症進行評估。結果:以食道超聲波評估 ASD 直徑平均為 14.3±4.1 毫米,而球囊測量方法結果為 19.2±4.7 毫米。所使用的閉合器直徑平均為 19.2±4.7 毫米(範圍 11-30 毫米)。手術中 X-光暴露時間為 17.3 分鐘(範圍 7.4-30 分鐘),平均手術時間 100 分鐘(範圍 35-190 分鐘)。全部手術過程順利。2 例患者曾出現一過性房室傳導阻滯,很短時間即自行恢復。缺孔的完全閉合率在 24 小時,1 週,1 月,6 月及12 月分別為 83%(90% 可信度範圍 73-91%);93%(90% 可信度範圍 84-97%);95%(90% 可信度範圍 81-96%)及 97%(90% 可信度範圍 91-99%)。平均隨訪期為 46.5±18.6 個月(範圍 10.7-86.6 月),隨訪結果顯示無一例發生延遲性併發症。所置入的所有閉合器都很穩固。結論:經心導管方法置入 Amplatzer ASD 閉合器治療兒童的 ASD 是一種安全而有效的治療方法。

Keyword : Amplatzer septal occluder; Children; Secundum atrial septal defect; Transcatheter closure

關鍵詞:Amplatzer ASD 閉合器、兒童、繼發孔 ASD、經心導管閉合術

 
 

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