目的：为了评价经导管用蘑菇双伞封堵继发孔型心房间隔缺损和随访结果。用哈壳闭合器或纽扣式装置经导管封堵继发孔型心房间隔缺损后有很高的残余分流发生率。近来，用动物实验模型评价了Amplatzer中心自膨型装置封堵心房间隔缺损获得了非常好的结果。本文报告经导管用蘑菇双伞封堵继发孔型心房间隔缺损临床经验。

方法：经导管用蘑菇双伞封堵继发孔型心房间隔缺损共28例患者，平均年龄20.2岁(5～62岁)，平均体重36 kg(17～78 kg)。经TTE测量的心房间隔缺损平均直径为15 mm(9～30 mm),用球囊测量的心房间隔缺损平均直径为18 mm(12～34 mm)。所有患者的右心房右心室都扩大，肺循环血流量/体循环血流量(QP/QS)2.7±0.8。所有患者分别用F8～12的导管释放蘑菇双伞。

结果：所有患者都能正确的置放蘑菇双伞，28例都能即可完全封堵心房间隔缺损。X线暴光的平均时间为13分(9～32分)。总的平均手术时间为92.5分(35～120分)。无一例发生蘑菇双伞栓塞和发生任何并发症。用经胸超声心动图(TTE)作1天、3月、6月和12月的术后随访。术后第1天TTE复查所有患者被完全封堵，3月后半年随访1次。无一例发生感染性心内膜炎、血栓栓塞和蘑菇双伞丝断裂。Amplatzer心房间隔封堵器对所有患者都是安全和有效的。

结论：经导管用蘑菇双伞封堵继发孔型心房间隔缺损是一种非常有效的非手术方法，仍需要进一步临床试验。该技术有很高的成功率，手术即刻和短期结果十分满意，但是还需要长期的随访。根据我们的临床经验经导管用蘑菇双伞封堵继发孔型心房间隔缺损是安全、可行和有效的技术，而且有很好前景。

Transcatheter Closure of Secundum Atrial Septal Defects Using Amplatzer Device

and its Follow-up Results (Abstract)

Department of Cardiology, 301 General Hospital, PLA., Beijing (100853)

Wang Guangyi, Chen Lian, Wen Chaoyang, et al.

Objective: To evaluate the efficiency and its follow-up results of transcatheter closure of secundum atrial septal defects (TCSASDs) using Amplatzer occluder device. TCSASDs Using clamshell or buttoned devices is accompanied by a high incidence of residual shunt. Recently, a new self-centering device, the Amplatzer atrial septal occluder (AASO), has been evaluated in an animal model with excellent results. This paper, however, is to report our clinical experience with this device.

Methods: Twenty-eight patients underwent an attempt of TCSASDs at a mean age of 20.2 yr (range, 5～62 yr) and mean wight of 36 kg (range 17～78 kg) using the AASO. The mean ASD diameter measured by transesophageal echocardiography (TEE) was 15 mm (range, 9～30 mm), and the mean ASD balloon stretched diameter was 18 mm (range, 12～34 mm). All patients had right atrial and ventricular volume overload with a QP/QS of 2.7±0.8. A F8-12 catheter was used for delivery of the device in all patients.

Results: The device was placed correctly in all patients. There was immediate and complete closure in 28 patients. The mean fluoroscopy time was 13 min (range, 9～32 min), and the mean total procedure time was 92.5 min (range, 35～120 min). There was no episode of device embolization or any other complication. Follow-up was performed using transthoracic echocardiography (TTE) 1 day, 1 month, 3 months, 6 months and 1 year after the procedure. The first day after operation, there was complete closure of the ASD in all patients, a mean follow-up interval of 6 months, there was no episodes of endocarditis, thromboembolism, or wire fracture. The AASO is safe and effective in all patients.

Conclusion: TCSASDs using Amplatzer occluder device is an excellently efficient nonsurgical method. It has a very high success rate with satisfied instant and short term results, but the long term follow-up were needed and according to our clinical experience, TCSASDs using Amplatzer occluder device is safe, feasible and effective and has a good prospect.