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首页> 外文期刊>Hong Kong Journal of Paediatrics >Transcatheter Closure of Right-to-Left Atrial Shunts Using Amplatzer Septal Occluder
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Transcatheter Closure of Right-to-Left Atrial Shunts Using Amplatzer Septal Occluder

机译：使用Amplatzer隔室封堵器从右到左心房分流导管封闭

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Purpose: We reviewed our experience in the closure of right-to-left atrial shunts using Amplatzer septal occluders. Methods: This is a retrospective review of 13 patients who underwent transcatheter closure of right-to-left atrial shunts for systemic hypoxaemia, at a median age of 8.0 years (range, 2.1 to 17.5), between April 1998 and March 2005. Results: The right-to-left shunts were associated with Fontan fenestrations (n=8), pulmonary atresia post right ventricular outflow tract reconstruction (RVOTR) (n=3), and critical pulmonary stenosis post-balloon valvoplasty (n=1) and RVOTR (n=1). The median procedural and fluoroscopic times were 140 minutes (range, 75 to 250) and 23 minutes (range, 13 to 55), respectively. A single occluder, with size ranging from six to 24 mm, was placed in 12 patients, while two (17 mm and 20 mm) occluders were deployed in one. There were no procedural failures or immediate complications. Systemic arterial oxygen saturation increased from 81.0±9.0% to 94.9±2.4% (p=0.008), while the mean right atrial pressure increased slightly from 11.8±3.6 to 13.5±3.5 mmHg (p=0.013) after the procedure. The median follow-up duration was 63 months (range, 7 to 75). One patient developed transient ischaemic attacks within the first week of device implantation. Follow-up echocardiography revealed no leak through the implanted devices, although residual shunts through additional small atrial communications were noted in four patients. Conclusion: Amplatzer septal occluder effectively eliminates right-to-left atrial shunts with significant improvement in systemic arterial oxygenation. Serial monitoring for systemic venous congestion is, however, warranted.
机译：目的：我们回顾了我们使用Amplatzer隔室封堵器封闭右向左心房分流的经验。方法：这是一项回顾性研究，回顾了1998年4月至2005年3月之间因中枢性低氧血症而从右至左心房分流行右导管分流术的13例患者的中位年龄为8.0岁（范围为2.1至17.5）。从右向左分流与Fontan开窗术（n = 8），右室流出道重建术后的肺动脉闭锁（RVOTR）（n = 3）以及气球瓣膜成形术后的严重肺动脉狭窄（n = 1）和RVOTR相关（n = 1）。中位手术时间和透视时间分别为140分钟（范围为75至250）和23分钟（范围为13至55）。将一个大小从6到24 mm的封堵器放置在12位患者中，而将两个封堵器（17 mm和20 mm）部署在一个封堵器中。没有手术失败或立即并发症。手术后，全身动脉血氧饱和度从81.0±9.0％增加到94.9±2.4％（p = 0.008），而平均右心房压力从11.8±3.6毫米汞柱略微增加到13.5±3.5 mmHg（p = 0.013）。中位随访时间为63个月（范围从7到75）。一名患者在装置植入的第一周内发生了短暂性脑缺血发作。随访的超声心动图检查显示没有通过植入装置泄漏，尽管在四名患者中发现了通过额外的小房室传导引起的残余分流。结论：Amplatzer隔室封堵器可有效消除从右到左的心房分流，显着改善全身动脉氧合。但是，需要对系统性静脉充血进行连续监测。

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