asdpfo封堵器血栓形成的认识PPT.ppt

广西医科大学第一附属医院 伍伟锋 ASD/PFO封堵器血栓形成的认识 Introduction Percutaneous ASD closure (1974, King) Closure of atrial septal communications, ASD and PFO from an open surgical technique to percutaneous, catheter-based, closure devices Currently available devices within the United States for percutaneous closure of atrial-level defects within randomized controlled trials Interventional Catheterization in Adult Congenital Heart Disease. Circulation 2007; 115;1622-1633 Complications can be unknown or under-estimated prior to general use relatively small and carefull selected patient population short duration of follow-up limited indications To review the rate of rare, but potentially serious complications highlighted 3 major complications device embolization (EM) device erosion (ER) thrombus formation 2-D and color Doppler TTE views of Aorto-atrial fistula. Am J Cardiol. 96: 1607–1609 Intraoperative photo, AGA device in place and arrow to fistula. Am J Cardiol.96: 1607–1609 Thrombus formation ASD/PFO封堵器血栓形成的临床诊断 封堵器血栓形成临床诊断主要依靠超声心动图，特别是经食管超声心动图（TEE） 超声心动图特征为封堵器表面新出现的非平面性异常回声，并且该结构部分可随血流而飘动 Figure A Transesophagealechocardiographyfour-chamberview:left-sided mobile thrombus attached to a StarFLEX occluder detected four Weeks after catheter closure. Figure B Transesophagealechocardiography short axis: right-andleft-sided immobile thrombus surrounding an ASDOS Occluder detected four weeks after catheter closure. Figure C Transesophageal echocardio-graphy short-axis: large mobile thrombus (30×18mm) Attached to the right atrial wall (without direct contact to the ASDOS device) detected one year after catheter closure. J Am Coll Cardiol,2004,43:302-309 Figure A short transesophageal view of small mobile left-sided thrombion a StarFLEX occluder. During surgery,the absence of the left-sided thrombi. But detection of a right-sided thrombus (8mm) not diagnosed before was removed together with the device. J Am Coll Cardiol,2004,43:302-309 对成人患者，无论超声声窗条件，应常规进行经TEE检查，分