以三度空間影像評估心房中隔缺損關閉器對於靜脈系統以及房室瓣膜之影響

Abstract

本研究目的在於評估以關閉器關閉心房中隔缺損後, 關閉器之位置, 心臟血 管之結構是否受影響。我們使用電腦斷層, 研究卅一例在本院接受以關閉器關閉 心房中隔缺損之病人, 在手術後6 個月至3.3 年後做電腦斷層檢查。這卅一例當 中在7 例接受Sideris 關閉器, 10 例以Starflex 關閉器及14 例Amplatzer 關閉器並 在電腦工作站重組三度空間的影像, 觀察關閉器位置肺靜脈及體靜脈系統是否 通暢, 二尖瓣及三尖瓣是否受影響。結果: 四例有部份肺靜脈迴流阻塞, ( 2 例為 Sideris 關閉器, 1 例Starflex, 另一例使用Amplatzer 關閉器 ), 其中有一例使用 Sideris 關閉器者, 發生一個金屬框架 (Arm) 滑入肺靜脈。另一例也是Sideris 關閉器使用者, 框架移入下腔靜脈, 另一例Starflex 之框架穿過心房室中隔膜。 無任何一例有上腔靜脈及矢狀竇之壓迫以及無一例關閉器會阻礙二尖瓣及三尖 瓣之功能。並以心臟超音波作為比較, 並無一例有肺靜脈或上腔靜脈迴流處阻 塞的情形, 但有四例可看到殘留的缺損及分流。結論: 電腦斷層影像可用於評估 以關閉器關閉心房中隔缺損後, 關閉器之形狀及位置以及肺靜脈及上下腔靜脈 是否有阻塞, 比超音波還要精確。

We conduct the study to assess device position, cardiovascular structure and morphology in patients who underwent transcatheter closure of atrial septal defect (ASD). METHODS: Electron-bean computerized tomography (CT) was performed in 31 patients who had undergone transcatheter ASD closure in this institution. The interval between ASD closure and CT imaging study ranged from 6 months to 3.3 years. Of the the 31 patients, Sideris device was deployed in 7, Starflex device in 10 and Amplatzer device in 14 patients. Three-dimensional reconstruction of the CT images was performed to evaluate the device position, patency of systemic and pulmonary venous pathway and morphology atrioventricular valves. RESULTS: Partial obstruction of a pulmonary vein was observed in 4 patients (2 with Sideris device, 1 with Starflex device and 1 with Amplatzer device). Migration of one arm to a pulmonary vein was observed in 1 with Sideris device. Migration of one arm to inferior vena cava was found in one with Sideris device. Impingement on atrioventricular septum by one arm of Starflex device was found in 1. One had one arm of Starflex device penetrating atrioventricular septum. One had residual shunt. None had systemic vena cavae or coronary sinus obstruction. None had impingement of device on mitral or tricuspid valve leaflets. Cross-sectional and Doppler echocardiographic studies in the 31 patients showed none had significant pulmonary or systemic venous pathway obstruction. A small left ventricle to right atrial shunt was found in the patient who had impingement on the atrioventricular septum. Trivial-to-mind residual shunt was found on the echocardiogram in 4 with Sideris device. CONCLUSION: CT images can be useful in the assessment of device position and systemic and pulmonary venous pathway in ASD patients following transcatheter closure.