先天性心脏病-房间隔缺损的手术治疗进展
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v7i4.15515
Abstract
房间隔缺损(atrial septal defect,ASD)是成人最常见的先天性心脏病之一,近年来治疗策略不断演进,涵盖传统正中开胸修补、各类微创手术与介入封堵术等多种路径。尽管多种术式在临床广泛应用,关于其适应证选择、术后并发症管理及远期疗效的争议仍未统一。本文系统梳理了近年ASD主流治疗方式的适用人群、技术特征、疗效数据及安全性结果,重点比较不同术式在复杂解剖条件、美容需求与围术期管理中的优势与局限。同时,本文提出“解剖结构—术式匹配—策略决策”三维评估模型,尝试为临床制定个体化治疗方案提供循证支持。通过批判性整合现有证据,本文为推动ASD治疗的微创化与精准化提供理论基础和实践参考。
Keywords
房间隔缺损；外科修补；介入封堵；微创手术；临床决策
Funding
青海省“昆仑英才-高端创新创业人才”项目,编号：青人才字[2025]5号。
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[5] BAUMGARTNER H,DE BACKER J,BABU-NARAYAN S V,et al. 2020 ESC Guidelines for the management of adult congenital heart disease[J].Eur Heart J,2021,42(6):563-645.
[6] ZHU J,ZHANG Y,BAO C,et al.Individualized strategy of mi nimally invasive cardiac surgery in congenital cardiac septal defects[J].J Cardiothorac Surg,2022,17(1):5.
[7] RIGATELLI G,ZUIN M,RONCON L,et al.Secundum atrial sep tal defects transcatheter closure versus surgery in adulthood: a 2000-2020 systematic review and meta-analysis of intrahosp ital outcomes[J].Cardiol Young,2021,31(4):541-6.
[8] ULLAH A,ZAHER A,SAHA H,et al.Comparison of Short-Te rm Outcomes: Minimally Invasive Thoracotomy Versus Median Sternotomy for Atrial Septal Defect Closure[J].Cureus,2025,17(1):e77898.
[9] LO RITO M,BRINDICCI Y C M,MOSCATIELLO M,et al.Minima lly Invasive Surgery for Simple Congenital Heart Defects:Pres erving Aesthetics without Jeopardizing Patient Safety[J]. J Cardiovasc Dev Dis,2023,10(11).
[10] LEI Y Q,LIU J F,XIE W P,et al. Anterolateral minithor acotomy versus median sternotomy for the surgical treatment of atrial septal defects:a meta-analysis and systematic revi ew[J].J Cardiothorac Surg,2021,16(1):266.
[11] BARBERO C,MARCHETTO G, PACE NAPOLEONE C,et al. Right mini-thoracotomy approach for grown-up congenital heart disease[J].J Card Surg,2021,36(6):1917-21.
[12] 李旭,向道康,兰萍,等.胸骨旁入路小切口手术治疗房间隔缺损的临床疗效分析[J].中国现代药物应用,2021,15(11):66-8.
[13] DODGE-KHATAMI J,DODGE-KHATAMI A,NGUYEN T D,et al. Minimal invasive approaches for pediatric & congenital heart surgery:safe,reproducible, more cosmetic than through stern otomy, and here to stay [J].Transl Pediatr,2023,12(9):1744-52.
[14] SAID S-M,GREATHOUSE K-C,MCCARTHY C,et al.Right Axi llary Thoracotomy vs.Median Sternotomy for Repair of Congenital Heart Defects in Infants and Children[J].Congeni tal Heart Disease, 2024,19(6):563-75.
[15] LUO Z R,CHEN Q,YU L L,et al.Comparative Study between Surgical Repair of Atrial Septal Defect via Median Sternotomy, Right Submammary Thoracotomy, and Right Vertical Infra-Axi llary Thoracotomy[J].Braz J Cardiovasc Surg,2020,35(3):285-90.
[16] YANG X,HU Y,DONG J,et al.Rightvertical axillary incisi on for atrial septal defect: a propensity score matched study [J].J Cardiothorac Surg,2022,17(1):256.
[17] WANG X,SUN H,MA B,et al.Thoracoscopic closure of atr ial septal defect in perfused beating hearts[J].Surg Endosc,2025,39(1):341-8.
[18] LIU X,WU Y,ZHU J,et al.Totally thoracoscopic repair of atrial septal defect reduces systemic inflammatory reaction and myocardial damage in initial patients[J].Eur J Med Res,2014,19(1):13.
[19] ZHENG X X,WANG Z Y,MA L Y,et al.Triport periareolar tho racoscopic surgery versus right minithoracotomy for repairi ng atrial septal defect in adults[J].Interact Cardiovasc Thor ac Surg,2021,32(2):313-8.
[20] DANG H Q,NGUYEN H C,LE T N.Totally Endoscopic Atrial Septal Defect Repair on Beating Heart: Clinical Outcome and Single-Surgeon Learning Curve Experience[J].Innovations (Ph ila),2023,18(6):574-82.
[21] JIANG Q,HUANG K,ZHAO D,et al.Innovations and Develop ments in Totally Thoracoscopic Cardiac Procedures[J].Heart Surgery Forum,2024,27(4):E424-E30.
[22] YE Z, LI Z,YI H,et al.Optimization of Echo Views for Per cutaneous Device Closure of Pediatric Atrial Septal Defect thr ough the Femoral Vein Guided by Transthoracic Echocardiogra phy without Radiation [J].J Interv Cardiol, 2020,2020:8242790.
[23] BARWAD P,NAGANUR S,SHARMA Y P,et al.Transcatheter cl osure of atrial septal defect(ASD)in adult and paediatric pop ulation without transoesophageal echocardiography/general anaesthesia[J].European Heart Journal,2024,45.
[24] 周奇,韩宇,宋书波,等.微创封堵治疗房间隔缺损的临床进展[J].中国胸心血管外科临床杂志,2021,28(12):1508-12.
[25] 王迪,赵鹏程,龚青云,等.经导管介入封堵与经胸微创封堵治疗房间隔缺损手术效果的Meta分析[J].临床心血管病杂志,2020,36(11):1019-24.
[26] 罗列.经胸与经皮房间隔缺损封堵术的临床疗效比较[J].赣南医学院学报,2022,42(02):164-6+86.
[27] SCHNEEBERGER Y,SCHAEFER A,CONRADI L,et al.Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care[J].Interact Cardiovasc Thorac Surg, 2017,24(4):603-8.
[28] MYLONAS K S,ZIOGAS I A,EVANGELIOU A,et al.Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis[J].Pediatr Cardiol,2020,41(5):853-61.
[29] GOH E,MOHAMMED H,SALMASI M Y,et al.Minimally invasi ve versus transcatheter closure of secundum atrial septal def ects: a systematic review and meta-analysis[J].Perfusion,2022,37(7):700-10.
[30] HANSEN J H,DUONG P,JIVANJI S G M,et al.Transcatheter Correction of Superior Sinus Venosus Atrial Septal Defects as an Alternative to Surgical Treatment[J].J Am Coll Cardiol,2020,75(11):1266-78.
[31] ROSENTHAL E,QURESHI S A,JONES M,et al.Correction of sinus venosus atrial septal defects with the 10 zig covered Cheatham-platinum stent-An international registry[J].Cathe ter Cardiovasc Interv,2021,98(1):128-36.
[32] SHI D,KANG Y,WANG W,et al.Biodegradable polymeric occluder with controllable locking structure for closure of atrial septal defect via interventional treatment[J].Regen Biomater,2025,12:rbaf016.
[33] SIEVERT K,BERTOG S,SöDERBERG B,et al.Transcatheter closure of atrial septal defect and patent foramen ovale with Carag bioresorbable septal occluder: first-in-man experien ce with 24-month follow-up[J].EuroIntervention,2022,17(18):1536-7.
[34] CALLEGARI A,QUANDT D,NORDMEYER J,et al.Transcathet er Closure of Atrial Septal Defect with Carag Bioresorbable Septal Occluder™:First-in-Child Experience with 12-MonthFo llow-Up[J].J Interv Cardiol,2022,2022:3476398.
[35] GONG X,YANG Y,ZHAO T,et al.Midterm follow-up results of implantation of a fully biodegradable ventricular septal defect occluder[J].Zhong Nan Da Xue Xue Bao Yi Xue Ban,2024,49(5):795-801.
[36] 赵迎澳,闫一鸣,李子平,等.单纯超声引导完全可降解封堵器经皮介入治疗房间隔缺损一例[J].中国胸心血管外科临床杂志,2024(04):1-4.
[2] BRIDA M,CHESSA M,CELERMAJER D,et al.Atrial septal def ect in adulthood: a new paradigm for congenital heart disease [J].Eur Heart J,2022,43(28):2660-71.
[3] 国家卫生健康委员会国家结构性心脏病介入质量控制中心,国家心血管病中心结构性心脏病介入质量控制中心,中华医学会心血管病学分会先心病经皮介入治疗指南工作组,et al.常见先天性心脏病经皮介入治疗指南(2021版)[J].中华医学杂志,2021,101(38):3054-76.
[4] 董卓亚,洪海筏.房间隔缺损治疗后远期疗效和预后的研究进展[J].现代实用医学,2023,35(01):132-6.
[5] BAUMGARTNER H,DE BACKER J,BABU-NARAYAN S V,et al. 2020 ESC Guidelines for the management of adult congenital heart disease[J].Eur Heart J,2021,42(6):563-645.
[6] ZHU J,ZHANG Y,BAO C,et al.Individualized strategy of mi nimally invasive cardiac surgery in congenital cardiac septal defects[J].J Cardiothorac Surg,2022,17(1):5.
[7] RIGATELLI G,ZUIN M,RONCON L,et al.Secundum atrial sep tal defects transcatheter closure versus surgery in adulthood: a 2000-2020 systematic review and meta-analysis of intrahosp ital outcomes[J].Cardiol Young,2021,31(4):541-6.
[8] ULLAH A,ZAHER A,SAHA H,et al.Comparison of Short-Te rm Outcomes: Minimally Invasive Thoracotomy Versus Median Sternotomy for Atrial Septal Defect Closure[J].Cureus,2025,17(1):e77898.
[9] LO RITO M,BRINDICCI Y C M,MOSCATIELLO M,et al.Minima lly Invasive Surgery for Simple Congenital Heart Defects:Pres erving Aesthetics without Jeopardizing Patient Safety[J]. J Cardiovasc Dev Dis,2023,10(11).
[10] LEI Y Q,LIU J F,XIE W P,et al. Anterolateral minithor acotomy versus median sternotomy for the surgical treatment of atrial septal defects:a meta-analysis and systematic revi ew[J].J Cardiothorac Surg,2021,16(1):266.
[11] BARBERO C,MARCHETTO G, PACE NAPOLEONE C,et al. Right mini-thoracotomy approach for grown-up congenital heart disease[J].J Card Surg,2021,36(6):1917-21.
[12] 李旭,向道康,兰萍,等.胸骨旁入路小切口手术治疗房间隔缺损的临床疗效分析[J].中国现代药物应用,2021,15(11):66-8.
[13] DODGE-KHATAMI J,DODGE-KHATAMI A,NGUYEN T D,et al. Minimal invasive approaches for pediatric & congenital heart surgery:safe,reproducible, more cosmetic than through stern otomy, and here to stay [J].Transl Pediatr,2023,12(9):1744-52.
[14] SAID S-M,GREATHOUSE K-C,MCCARTHY C,et al.Right Axi llary Thoracotomy vs.Median Sternotomy for Repair of Congenital Heart Defects in Infants and Children[J].Congeni tal Heart Disease, 2024,19(6):563-75.
[15] LUO Z R,CHEN Q,YU L L,et al.Comparative Study between Surgical Repair of Atrial Septal Defect via Median Sternotomy, Right Submammary Thoracotomy, and Right Vertical Infra-Axi llary Thoracotomy[J].Braz J Cardiovasc Surg,2020,35(3):285-90.
[16] YANG X,HU Y,DONG J,et al.Rightvertical axillary incisi on for atrial septal defect: a propensity score matched study [J].J Cardiothorac Surg,2022,17(1):256.
[17] WANG X,SUN H,MA B,et al.Thoracoscopic closure of atr ial septal defect in perfused beating hearts[J].Surg Endosc,2025,39(1):341-8.
[18] LIU X,WU Y,ZHU J,et al.Totally thoracoscopic repair of atrial septal defect reduces systemic inflammatory reaction and myocardial damage in initial patients[J].Eur J Med Res,2014,19(1):13.
[19] ZHENG X X,WANG Z Y,MA L Y,et al.Triport periareolar tho racoscopic surgery versus right minithoracotomy for repairi ng atrial septal defect in adults[J].Interact Cardiovasc Thor ac Surg,2021,32(2):313-8.
[20] DANG H Q,NGUYEN H C,LE T N.Totally Endoscopic Atrial Septal Defect Repair on Beating Heart: Clinical Outcome and Single-Surgeon Learning Curve Experience[J].Innovations (Ph ila),2023,18(6):574-82.
[21] JIANG Q,HUANG K,ZHAO D,et al.Innovations and Develop ments in Totally Thoracoscopic Cardiac Procedures[J].Heart Surgery Forum,2024,27(4):E424-E30.
[22] YE Z, LI Z,YI H,et al.Optimization of Echo Views for Per cutaneous Device Closure of Pediatric Atrial Septal Defect thr ough the Femoral Vein Guided by Transthoracic Echocardiogra phy without Radiation [J].J Interv Cardiol, 2020,2020:8242790.
[23] BARWAD P,NAGANUR S,SHARMA Y P,et al.Transcatheter cl osure of atrial septal defect(ASD)in adult and paediatric pop ulation without transoesophageal echocardiography/general anaesthesia[J].European Heart Journal,2024,45.
[24] 周奇,韩宇,宋书波,等.微创封堵治疗房间隔缺损的临床进展[J].中国胸心血管外科临床杂志,2021,28(12):1508-12.
[25] 王迪,赵鹏程,龚青云,等.经导管介入封堵与经胸微创封堵治疗房间隔缺损手术效果的Meta分析[J].临床心血管病杂志,2020,36(11):1019-24.
[26] 罗列.经胸与经皮房间隔缺损封堵术的临床疗效比较[J].赣南医学院学报,2022,42(02):164-6+86.
[27] SCHNEEBERGER Y,SCHAEFER A,CONRADI L,et al.Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care[J].Interact Cardiovasc Thorac Surg, 2017,24(4):603-8.
[28] MYLONAS K S,ZIOGAS I A,EVANGELIOU A,et al.Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis[J].Pediatr Cardiol,2020,41(5):853-61.
[29] GOH E,MOHAMMED H,SALMASI M Y,et al.Minimally invasi ve versus transcatheter closure of secundum atrial septal def ects: a systematic review and meta-analysis[J].Perfusion,2022,37(7):700-10.
[30] HANSEN J H,DUONG P,JIVANJI S G M,et al.Transcatheter Correction of Superior Sinus Venosus Atrial Septal Defects as an Alternative to Surgical Treatment[J].J Am Coll Cardiol,2020,75(11):1266-78.
[31] ROSENTHAL E,QURESHI S A,JONES M,et al.Correction of sinus venosus atrial septal defects with the 10 zig covered Cheatham-platinum stent-An international registry[J].Cathe ter Cardiovasc Interv,2021,98(1):128-36.
[32] SHI D,KANG Y,WANG W,et al.Biodegradable polymeric occluder with controllable locking structure for closure of atrial septal defect via interventional treatment[J].Regen Biomater,2025,12:rbaf016.
[33] SIEVERT K,BERTOG S,SöDERBERG B,et al.Transcatheter closure of atrial septal defect and patent foramen ovale with Carag bioresorbable septal occluder: first-in-man experien ce with 24-month follow-up[J].EuroIntervention,2022,17(18):1536-7.
[34] CALLEGARI A,QUANDT D,NORDMEYER J,et al.Transcathet er Closure of Atrial Septal Defect with Carag Bioresorbable Septal Occluder™:First-in-Child Experience with 12-MonthFo llow-Up[J].J Interv Cardiol,2022,2022:3476398.
[35] GONG X,YANG Y,ZHAO T,et al.Midterm follow-up results of implantation of a fully biodegradable ventricular septal defect occluder[J].Zhong Nan Da Xue Xue Bao Yi Xue Ban,2024,49(5):795-801.
[36] 赵迎澳,闫一鸣,李子平,等.单纯超声引导完全可降解封堵器经皮介入治疗房间隔缺损一例[J].中国胸心血管外科临床杂志,2024(04):1-4.
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