- 學位論文
探討使用心導管關閉繼發孔型心房中膈缺損之關閉器尺寸過大的偏差
Investigate the Deviation of the Device Size Choice when Using Transcatheter Closure of Secundum Atrial Septal Defects
摘要
研究目的 心房中膈缺損為常見的先天性心臟病，治療方式以介入性心導管，使用Amplatzer心中膈關閉器將缺損修補起來。在關閉器的尺寸選擇有很多種方式，而尺寸的正確與否很重要，尺寸過大會造成房室傳導阻滯、關閉器無法完全展開變成蘑菇狀、無法緊貼心房中膈、內皮細胞生長包覆所需的時間拉長，增加併發症的風險。 本研究的目的是希望透過此回溯性實驗，檢視治療前缺損大小與治療後關閉器展開腰部大小，評估關閉器尺寸誤差，並探討造成尺寸誤判的型態和原因，希望可以找出選擇關閉器尺寸的最佳評估方式，以降低產生併發症的風險。 材料與方法 本研究主題一為中國醫藥大學兒童醫院，收取100位患者資料，該單位使用的關閉器大小選擇依據為球囊量測法，收取資料包含經胸前心臟超音波、球囊腰部尺寸、關閉器尺寸、以置入後展開腰部大小做為黃金標準，分析球囊膨脹型態、絕對誤差及相對誤差。 主題二為溫州醫科大學附屬第一醫院，同樣收取100位患者資料，該單位使用的關閉器選擇依據為三維經食道心臟超音波，收取資料包含經胸前心臟超音波、經食道心臟超音波、關閉器尺寸、以置入後展開腰部大小做為黃金標準，分析其絕對誤差及相對誤差。 結果 根據本研究的統計，心導管的球囊型態分為槓鈴型及子彈型，當心房中膈缺損較小，在球囊充滿時呈槓鈴型，選擇關閉器尺寸較小；心房中膈缺損較大，在球囊充滿時呈子彈型，選擇的關閉器尺寸較大。在槓鈴型的球囊絕對誤差為1.96 ± 0.96 mm，相對誤差41.73±23.09%；子彈型的球囊絕對誤差2.78±1.46 mm，相對誤差為16.03±9.59%。 結論 而透過本研究中不同年齡層的比較，我們也認為在成人的患者中使用3D-TEE是較為理想的，而兒童的患者則仍須採用球囊量測法較為安全。若使用球囊量測法或經食道心臟超音波，皆可分別代入本研究所得之回歸公式，所得到的數值會最接近缺損的實際大小，可以此公式作為臨床參考，盡量避免尺寸過大的案例。
並列摘要
Purpose Atrial septal defect is a common congenital congenital heart disease. The treatment is performed with an interventional cardiac catheter, and the defect is repaired using the Amplatzer septal occluder. There are many ways to choose the size of the device, and the correct size is very important. If the size is too large, it will cause atrioventricular block, the device can not be fully expanded into a mushrooming. The device may not be close to the atrial septum, and endothelial cell growth coverage requires more time, increasing the risk of complications. The purpose of this study is to examine the size of the defect before treatment and the size of the device waist after treatment. We evaluate the error of the device and explore the type and cause of the misjudgment. We hope to find the best way to evaluate the size of the device to reduce the risk of complications. Materials and Methods The first topic of this study is the Children's Hospital of China Medical University, which collects 100 patients data. The size of the device used by the unit is based on the balloon measurement method. The data includes the transthoracic echocardiography(TTE), the balloon waist size, the device size and the size of the device waist. The device waist was set as the gold standard, and the balloon inflation type, absolute error and relative error were analyzed. The second topic of this study is the First Affiliated Hospital of Wenzhou Medical University, which collect 100 patients data. The size of the device used by the unit is based on three-dimensional transesophageal echocardiography(3D-TEE). The data includes the TTE, 3D-TEE, the device size and the size of the device waist. The device waist was set as the gold standard, and the balloon inflation type, absolute error and relative error were analyzed. Results According to the statistics of this study, the balloon type of cardiac catheter is divided into barbell type and bullet type. When the atrial septal defect is small, the barbell type is used when the balloon is full, and the size of the closing device is small. When the atrial septal defect is large, the bullet type is used when the balloon is full, and the size of the closing device is large. The absolute error of the balloon in the barbell type is 1.96 ± 0.96 mm, the relative error is 41.73±23.09%; the absolute error of the bullet type balloon is 2.78±1.46 mm, and the relative error is 16.03±9.59%. Conclusion Through the comparison of different age groups in this study, we also believe that using 3D-TEE in adult patients is ideal, and children patients still need to use balloon measurement is safer. If we use balloon measurement or TEE, we can substitute the regression formula obtained in this study, and the value obtained will be closest to the actual size of the defect. We can use this formula as a clinical reference and try to avoid oversizing.
參考文獻
延伸閱讀
- Ho, C. L., Fu, Y. C., Jan, S. L., Lin, M. C., Chi, C. S., & Hwang, B. T. (2006). 經心導管同時關閉心房中隔缺損及開放性動脈導管：兩病例報告. Acta Paediatrica Taiwanica, 47(4), 197-199. https://doi.org/10.7097/APT.200608.0197
- Lin, M. C., Fu, Y. C., Jan, S. L., Lin, W. W., Chu, K. H., Ting, C. T., Chen, Y. T., & Chi, C. S. (2005). 經心導管使用Amplatzer中膈關閉器關閉第二型心房中膈缺損：台灣一醫學中心的初步結果. Acta Paediatrica Taiwanica, 46(1), 17-23. https://doi.org/10.7097/APT.200502.0017
- Lin, M. C., Fu, Y. C., Jan, S. L., Ho, C. L., Chi, C. S., & Hwang, B. (2007). 經心導管使用安普拉茲封堵器關閉大型存開性動脈導管. Acta Cardiologica Sinica, 23(2), 103-108. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200706-23-2-103-108-a
- 吳焜烺（2022）。心室中膈缺損免開胸，心導管放置「關閉器」可改善。彰基院訊，39(2)，10-11。https://www.airitilibrary.com/Article/Detail?DocID=P20140814001-202202-202202080028-202202080028-10-11
- Chien, S. J., Chang, J. P., Ko, S. F., Lin, Y. J., Huang, C. F., Lin, I. C., Lo, M. H., Chang, H. W., & Liang, C. D. (2011). Long-Term Outcome of Outlet-Type Ventricular Septal Defect: Focus on Congestive Heart Failure and Aortic Valve Disorder. Acta Cardiologica Sinica, 27(3), 197-203. https://www.airitilibrary.com/Article/Detail?DocID=10116842-201109-201109300004-201109300004-197-203