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。