asdpfo封堵器血栓形成地认识.ppt

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 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 Device embolization Embolization rate AGA device 0.5%, 70% of the devices successfully retrieved percutaneously NMT device 4% in European studies 1–2% world-wide. Device erosion NMT devices only 1 case report AGA devices Numerous case reports In the United States estimated 9000 implants, 14 events were reported with confirmed erosions and 3 deaths 0.1% incidence of this complication, but a 20% mortality risk with it occurs 2-D and color Doppler TTE views of Aorto-atrial 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 对成人患者，无论超声声窗条件，应常规进行经TEE检查，分别在术后4周、6个月、12个月进行 对儿童患者随访，经胸超声心动图（TTE）已足够 ASD/PFO封堵器血栓形成的发生率 不同种类ASD/PFO封堵器血栓形成的发生率 La Rosee等描述38例ASD患者有3例（10.5%）血栓形成，60例PFO患者有8例（13.3 %）血栓形成 Lambert V等报道使用ASDOS封堵器139名患者中有9名血栓形成，血栓发病率6.5% Buttoned封堵器27名患者中有3名血栓形成，血栓发病率11.1% 表1 单中心不同类型封堵器术后4周和6个月时TEE检出血栓情况 Amplatzer与CardioSEAL、Star FLEX 、PFO-Star之间血栓形成率有显著性差异 （p0.05） （资料来自Cardiovascular Center Frankfurt,SanktKatharinen, Frankfurt, Germany） 最近Jeffrey 等为了回顾美国FDA从2002年开始准入的２种ASD/PFO封堵器（AGA和NMT）严重并发症发生情况 有哪些信誉好的足球投注网站了2002-　2004年MEDLINE和MAUDE的AGA和NMT公司的ASD/PFO封堵器的严重并发症文献与数据库资料 (MAUDE:制造商和用户的器械使用状况数字库) MEDLINE search using the MeSH terms “Atrial septal defect closure,” “Amplatz,” “Device closure