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1、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IntroductionPercutaneousASDclosure(1974,King)Closureofatrialseptalcommunications,ASDandPFOfromanopensurgicaltechniquetopercutaneous,catheter-based,closuredevicesCurrentlyavailabledeviceswithintheUnitedStatesforpercutaneousclosureofatrial-leveldefectswithinr
2、andomizedcontrolledtrialsInterventionalCatheterizationinAdultCongenitalHeartDisease.Circulation2007;115;1622-1633Complicationscanbeunknownorunder-estimatedpriortogeneraluserelativelysmallandcarefullselectedpatientpopulationshortdurationoffollow-uplimitedindicationsToreviewtherateofrare,bu
3、tpotentiallyseriouscomplicationshighlighted3majorcomplicationsdeviceembolization(EM)deviceerosion(ER)thrombusformationDeviceembolizationEmbolizationrateAGAdevice0.5%,70%ofthedevicessuccessfullyretrievedpercutaneouslyNMTdevice4%inEuropeanstudies1–2%world-wide.LeviDS,MooreJW.Embolizationand
4、retrievaloftheamplatzerseptaloccluder.CatheterCardiovascInterv.2004;61:543–547DeviceerosionNMTdevicesonly1casereportAGAdevicesNumerouscasereportsIntheUnitedStatesestimated9000implants,14eventswerereportedwithconfirmederosionsand3deaths0.1%incidenceofthiscomplication,buta20%mortalityriskwi
5、thitoccursJeffreyW.Delaney,MD,JenniferS.Li,MD,andJohnF.Rhodes,CongenitHeartDis,2007,2:256–264.2-DandcolorDopplerTTEviewsofAorto-atrialfistula.AmJCardiol.96:1607–1609Intraoperativephoto,AGAdeviceinplaceandarrowtofistula.AmJCardiol.96:1607–1609ThrombusformationASD/PFO封堵器血栓形成的临床诊断封堵器血栓形成临床诊断
6、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FigureATransesophagealechocardiographyfour-chamberview:left-sidedmobilethrombusattachedtoaStarFLEXoccluderdetectedfourWeeksaftercatheterclosure.FigureBTransesophagealechocardiographyshortaxis:right-andleft-sidedimmobilethro
7、mbussurroundinganASDOSOccluderdetectedfourweeksaftercatheterclosure.FigureCTransesophagealechocardio-graphyshort-axis:largemobilethrombus(30×18mm)Attachedtotherightatrialwall(withoutdirectcontacttotheASDOSdevice)detectedoneyearaftercatheterclosure.JAmCollCardiol,200
