Morphological study of defects of the atrial septum within the oval fossa: implications for transcatheter closure of left-to-right shunt.
Morphological study of defects of the atrial septum within the oval fossa: implications for transcatheter closure of left-to-right shunt.
复制标题
卵圆窝内房间隔缺损的形态学研究：对经导管封闭左向右分流的影响。
DOI：
10.1136/hrt.67.4.316
复制
发表时间：
1992
影响因子：
--
通讯作者：
R. Anderson
中科院分区：
文献类型：
--
作者：
S. M. Ferreira;S. Ho;R. Anderson
目的——确定房间隔缺损病例中卵圆窝的解剖变异性，并找出哪些因素可能使此类缺损适合或不适合通过伞形或蛤壳式装置闭合。设计--对100个卵圆窝内房间隔缺损的标本进行了研究，特别是缺损在卵圆窝内的位置；缺陷面积相对于卵圆窝总面积的比例；卵圆窝的边缘和瓣膜的形状；以及咽鼓和底比斯瓣膜的解剖变异性。结果：4例卵圆窝移位至下腔静脉口；移位至上腔静脉口2例；置于房间壁中部43；或稍微靠近下腔静脉51。由于其形状，29 颗心脏被认为不适合经导管闭合缺损。这是因为缺陷太大（16颗心）；卵圆窝移位至下腔静脉口（四颗心）或上腔静脉口（两颗心）；缺少前缘（两颗心）；缺少后下缘（一颗心）；因为厚的咽鼓瓣向后移位，形成假后下缘（一颗心）；或者因为卵圆窝底部的插入线距离左心房（三颗心）太远。结论——68 颗心脏似乎是经导管封堵术的理想候选者； 3 可能比较合适；但有29个不合适。这些形态上的变化可能可以解释为什么该手术在许多情况下都不成功。在尝试经导管封堵之前应对患者进行筛查。
OBJECTIVE--To determine the anatomical variability of the oval fossa in cases of atrial septal defect and to find out which factors might make such defects suitable or unsuitable for closure by umbrella or clamshell devices. DESIGN--100 specimens with defects of the atrial septum within the oval fossa were studied, especially the position of the defects within the fossa; the area of the defect in relation to the total area of the oval fossa; the shape of the rims and flap valve of the oval fossa; and the anatomical variability in the eustachian and thebesian valves. RESULTS--The oval fossa was displaced to the mouth of the inferior caval vein in four cases; displaced to the mouth of superior caval vein in two cases; placed on the middle of the interatrial wall in 43; or placed slightly towards the inferior caval vein in 51. Because of their shape 29 of the hearts were considered to be unsuitable for transcatheter closure of the defect. This was because the defect was too large (16 hearts); the oval fossa was displaced to the mouth of the inferior caval vein (four hearts) or to the superior caval vein (two hearts); lacked its anterior rim (two hearts); lacked the posteroinferior rim (one heart); because a thick eustachian valve was displaced posteriorly forming a false posteroinferior rim (one heart); or because the strand of insertion of the floor of the oval fossa was too distant from the left atrial aspect (three hearts). CONCLUSION--68 hearts appeared to be ideal candidates for transcatheter closure; 3 would probably have been suitable; but 29 were unsuitable. These morphological variations might explain why the procedure has been unsuccessful in so many cases. Patients should be screened before any attempt is made at transcatheter closure.