https://scholars.lib.ntu.edu.tw/handle/123456789/194573
標題: | 四十歲以上的心房中隔缺損病人心導管關閉與開刀兩種治療方法追蹤結果之比較 | 作者: | 王主科 | 關鍵字: | Adults;atrial septal defect;transcatheter closure;Amplatzer septal occluder | 公開日期: | 2005 | 出版社: | 臺北市:國立臺灣大學醫學院小兒科 | 摘要: | 目的: 探討「心導管關閉心房中隔 缺損」的技術治療40 歲以上的病 人是否安全,成效如何,並與同 年齡層病人之開刀結果做比較 方法與結果: 1.方法: 這是個回溯性研究,過去七 年當中(1998 至2005 年) 40 歲以 上的心房中隔缺損病人在本院接 受心導管治療共86 人,(40 歲至 81 歲,中位數51 歲),另一組為 同年齡層心房中隔缺損病人在過 去十年間,排除合併其他心臟疾 病者,(1996 至2005 年)在本院 接受開刀者共49 人,年齡由41 歲至72 歲不等,比較兩組間成功 率及併發症比率之差異。 2.結果: (1)以心導管治療的病人86 例病 人當中,83 人有右心室擴大,84 人有心臟症狀,11 人有心律不 整,Qp/Qs 值平均為3 ± 0.9,有 吸率不整的人年紀明顯較老(64 ± 9 vs. 52 ± 7, p ‹0.01) 缺損 平均值徑為23 ± 6.8 mm (11 至 35 mm 不等),13 人有多孔型缺 損,50 人有肺動脈高血壓(肺動 脈平均壓≧ mm 20 Hg),86 人 缺損皆可用心導管關閉,84 人使 用Amplatzer septal occluder,1 人使用CardioSeal, 另一人使用Buttoned device, 有6 人使用穿孔型關閉器 (fenestrated device),因為這 6 個人有明顯的心臟衰竭。有一 人有併發症發生心包膜充填,需 要抽出新包膜液,其餘無明顯併 發症,術後每日服用aspirin 200mg 共6 個月。 追蹤期間平均為2.9 ± 1.4 年,症狀改善者有85 人,僅有1 人沒改善,沒有新發生的中風,4 人仍有極小滲漏,追蹤期間仍有 肺動脈壓升高者有1 位,術前有 心律不整11 人中,5 人仍有心律 不整。另有2 人術後發生短暫性 的心房顫抖(atrial fibrillation) ,住院日平均為 3 天。 (2)心導管與開刀比較 這十年當中40 歲以上心房中 隔缺損接受開刀者共有49 人,手 術無人死亡,但有11 人術後發生 心包膜充填(1/86 vs. 11/49, P‹ 0.01)49 人術前有8 人有心律不 整,術後有顯著心律不整病人共 有14 人。 2 結論: 經由心導管治四十歲以上 的心房中隔缺損是個相當安全 而有效的方式,與開刀的結果 相比繳,併發症較少 To present the short-and mid-term results of transcatheter closure of atrial septal defect (ASD) in patients older than 40 years. Between January 1998 and September 2005, transcatheter closure of ASD was attempted in 86 patients (18 males) above 40 years of age (aged ranging from 40 to 81 years, median 51). All except 2 patients were symptomatic. Deployment of device was performed under general anesthesia and transesophageal echocardiographic monitoring. The results of transcatheter closure were compared with those of surgery in the past 10 years. Of the 86 patients, Enlargement of right ventricle was documented on the echocardiography in 83. Atrial arrhythmia was present in 11 patients. Patients with atrial arrhythmia was significantly older than those without. (64 ± 9 vs. 52 ± 7 years, P < 0.01) The mean Qp/Qs ratio was 3.11 ± 0.99 (ranging from 1.5 to 6.4). The mean stretched diameter of the defect was 23 ± 6.8 mm. (ranging from 11 to 35 mm) Thirteen patients had multiple defects. Pulmonary hypertension was present in 50 patients. The procedure was successful in all 86 patients. Amplatzer septal occluder (ASO) was used in 84 patients, CardioSeal device in 1 and Buttoned device in remaining 1. Six underwent ASD closure with a fenestrated device because of presence of significant heart failure. Five underwent implantation using 2 ASO devices. During the procedure, 2 experienced supraventricular tachycardia which was treated with cardioversion. One complicated with tamponade requiring drainage. One had a distal embolism to a finger tip 2 days after the procedure. The mean follow-up period is 2.9 ± 1.4 years. Four had small residual shunt in the latest follow-up of whom 2 had multiple defects. Pulmonary hypertension and right ventricular enlargement persisted in 1 and 4 patients respectively, in the latest echocardiographic follow-up. Symptomatic improvement was documented in all except 1. Of the 11 patients with atrial arrhythmias, 6 patients recovered to sinus rhythm and 5 had persisted atrial arrhythmias in the latest follow-up. Two had new onset atrial arrhythmia 3-months following the procedure. In the past 10 years, surgery for ASD was performed in 49 patients. Eleven of them developed post-operative pericardial effusion. (1/86 vs. 11/49, P ‹0.001 ). Eight patients had significant arrhythmia. 4 Transcatheter closure of ASD in patients above 40 years of age is safe and effective where patients may benefit from the procedure. Surgery carries a higher risk of postoperative pericardial effusion than transcatheter closure. Abbreviations: Atrial septal defect (ASD) Transesophageal echocardiography (TEE) |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/22912 | 其他識別: | 932314B002132 | Rights: | 國立臺灣大學醫學院小兒科 |
顯示於: | 醫學系 |
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932314B002132.pdf | 283.96 kB | Adobe PDF | 檢視/開啟 |
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