儿童房间隔缺损手术治疗的研究现状
Current State of Research on Surgical Procedures for Atrial Septal Defects in Children
DOI: 10.12677/acm.2026.161099, PDF,   
作者: 张修雄威, 代江涛*：重庆医科大学附属儿童医院胸心外科，儿童少年健康与疾病国家临床医学研究中心，儿童发育疾病研究教育部重点实验室，结构性出生缺陷与器官修复重建重庆市重点实验室，重庆
关键词: 房间隔缺损；儿童患者；介入封堵；手术治疗；研究进展；Atrial Septal Defect； Pediatric Patient； Transcatheter Closure； Surgical Treatment； Research Progress
摘要: 房间隔缺损(atrial septal defect, ASD)是常见的先天性心脏病之一。随着医疗技术的飞速发展，儿童患者的治疗策略已从传统的体外循环下胸部正中切口外科手术修补，发展为包括体外循环下右侧腋下ASD手术修补，体外循环胸腔镜辅助下ASD修补，经股静脉X线引导下或食管超声引导下介入封堵等多种模式并存的局面。本综述旨在系统回顾ASD手术治疗的背景与现状，对比国内外研究进展，分析不同治疗方法及适应症、优缺点及选择策略，并展望机器人辅助下手术、可降解封堵器等未来发展趋势。
Abstract: Atrial Septal Defect (ASD) is one of the common congenital heart diseases. With the rapid advancement of medical technology, the treatment strategies for pediatric patients have evolved from the traditional surgical repair via median sternotomy under cardiopulmonary bypass. Currently, a coexisting landscape of multiple modalities has emerged, including surgical repair via a right subaxillary approach under cardiopulmonary bypass, thoracoscopy-assisted ASD repair under cardiopulmonary bypass, and transcatheter closure via the femoral vein under fluoroscopic or transesophageal echocardiographic guidance. This review aims to systematically delineate the background and current state of surgical interventions for ASD, compare domestic and international research progress, analyze the different treatment methods along with their indications, advantages, disadvantages, and selection strategies. Furthermore, it will explore future trends, such as robot-assisted surgery and biodegradable occluders.
文章引用：张修雄威, 代江涛. 儿童房间隔缺损手术治疗的研究现状[J]. 临床医学进展, 2026, 16(1): 743-751. https://doi.org/10.12677/acm.2026.161099

参考文献

[1] Geva, T., Martins, J.D. and Wald, R.M. (2014) Atrial Septal Defects. The Lancet, 383, 1921-1932. [Google Scholar] [CrossRef] [PubMed]
[2] Borow, K.M. and Karp, R. (1990) Atrial Septal Defect. New England Journal of Medicine, 323, 1698-1700. [Google Scholar] [CrossRef] [PubMed]
[3] Shah, D., Azhar, M., Oakley, C.M., Cleland, J.G.F. and Nihoyannopoulos, P. (1994) Natural History of Secundum Atrial Septal Defect in Adults after Medical or Surgical Treatment: A Historical Prospective Study. Heart, 71, 224-228. [Google Scholar] [CrossRef] [PubMed]
[4] Brida, M., Chessa, M., Celermajer, D., Li, W., Geva, T., Khairy, P., et al. (2022) Atrial Septal Defect in Adulthood: A New Paradigm for Congenital Heart Disease. European Heart Journal, 43, 2660-2671. [Google Scholar] [CrossRef] [PubMed]
[5] Murphy, J.G., Gersh, B.J., McGoon, M.D., Mair, D.D., Porter, C.J., Ilstrup, D.M., et al. (1990) Long-Term Outcome after Surgical Repair of Isolated Atrial Septal Defect. New England Journal of Medicine, 323, 1645-1650. [Google Scholar] [CrossRef] [PubMed]
[6] Ooi, Y.K., Kelleman, M., Ehrlich, A., Glanville, M., Porter, A., Kim, D., et al. (2016) Transcatheter versus Surgical Closure of Atrial Septal Defects in Children: A Value Comparison. JACC: Cardiovascular Interventions, 9, 79-86. [Google Scholar] [CrossRef] [PubMed]
[7] Masura, J., Gavora, P., Formanek, A. and Hijazi, Z.M. (1997) Transcatheter Closure of Secundum Atrial Septal Defects Using the New Self-Centering Amplatzer Septal Occluder: Initial Human Experience. Catheterization and Cardiovascular Diagnosis, 42, 388-393. [Google Scholar] [CrossRef] [PubMed]
[8] Butera, G., Biondi-Zoccai, G., Sangiorgi, G., Abella, R., Giamberti, A., Bussadori, C., et al. (2011) Percutaneous versus Surgical Closure of Secundum Atrial Septal Defects: A Systematic Review and Meta-Analysis of Currently Available Clinical Evidence. EuroIntervention, 7, 377-385. [Google Scholar] [CrossRef] [PubMed]
[9] Berger, F., Vogel, M., Alexi-Meskishvili, V. and Lange, P.E. (1999) Comparison of Results and Complications of Surgical and Amplatzer Device Closure of Atrial Septal Defects. The Journal of Thoracic and Cardiovascular Surgery, 118, 674-680. [Google Scholar] [CrossRef] [PubMed]
[10] Du, Z., Hijazi, Z.M., Kleinman, C.S., Silverman, N.H. and Larntz, K. (2002) Comparison between Transcatheter and Surgical Closure of Secundum Atrial Septal Defect in Children and Adults: Results of a Multicenter Nonrandomized Trial. Journal of the American College of Cardiology, 39, 1836-1844. [Google Scholar] [CrossRef] [PubMed]
[11] Krumsdorf, U., Ostermayer, S., Billinger, K., Trepels, T., Zadan, E., Horvath, K., et al. (2004) Incidence and Clinical Course of Thrombus Formation on Atrial Septal Defect and Patient Foramen Ovale Closure Devices in 1,000 Consecutive Patients. Journal of the American College of Cardiology, 43, 302-309. [Google Scholar] [CrossRef] [PubMed]
[12] Feltes, T.F., Bacha, E., Beekman, R.H., Cheatham, J.P., Feinstein, J.A., Gomes, A.S., et al. (2011) Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease: A Scientific Statement from the American Heart Association. Circulation, 123, 2607-2652. [Google Scholar] [CrossRef] [PubMed]
[13] Maeßen, T., Korir, N., Van de Velde, M., Kennes, J., Pogatzki-Zahn, E. and Joshi, G.P. (2023) Pain Management after Cardiac Surgery via Median Sternotomy: A Systematic Review with Procedure-Specific Postoperative Pain Management (PROSPECT) Recommendations. European Journal of Anaesthesiology, 40, 758-768. [Google Scholar] [CrossRef] [PubMed]
[14] Luo, F. and Bu, H. (2022) Strategies to Evaluate Early Sternal Stability after Median Sternotomy in Young Children. The Annals of Thoracic Surgery, 114, 1987-1988. [Google Scholar] [CrossRef] [PubMed]
[15] Yaliniz, H., Topcuoglu, M.S., Gocen, U., Atalay, A., Keklik, V., Basturk, Y., et al. (2015) Comparison between Minimal Right Vertical Infra-Axillary Thoracotomy and Standard Median Sternotomy for Repair of Atrial Septal Defects. Asian Journal of Surgery, 38, 199-204. [Google Scholar] [CrossRef] [PubMed]
[16] Vida, V.L., Tessari, C., Fabozzo, A., Padalino, M.A., Barzon, E., Zucchetta, F., et al. (2013) The Evolution of the Right Anterolateral Thoracotomy Technique for Correction of Atrial Septal Defects: Cosmetic and Functional Results in Prepubescent Patients. The Annals of Thoracic Surgery, 95, 242-247. [Google Scholar] [CrossRef] [PubMed]
[17] Li, F., Cheng, T., Yan, M., Li, T., Zhang, T., Huang, Y., et al. (2024) Analysis of the Therapeutic Effect of Right Mid-Axillary Approach in the Surgical Treatment of ASD and VSD in Children. Journal of Cardiothoracic Surgery, 19, Article No. 587. [Google Scholar] [CrossRef] [PubMed]
[18] Baumgartner, H., Bonhoeffer, P., De Groot, N.M.S., de Haan, F., Deanfield, J.E., Galie, N., et al. (2010) ESC Guidelines for the Management of Grown-Up Congenital Heart Disease (New Version 2010): The Task Force on the Management of Grown-Up Congenital Heart Disease of the European Society of Cardiology (ESC). European Heart Journal, 31, 2915-2957. [Google Scholar] [CrossRef] [PubMed]
[19] Bacher, K., Bogaert, E., Lapere, R., De Wolf, D. and Thierens, H. (2005) Patient-Specific Dose and Radiation Risk Estimation in Pediatric Cardiac Catheterization. Circulation, 111, 83-89. [Google Scholar] [CrossRef] [PubMed]
[20] Jingquan, Z., Deyong, L., Huimin, C., Hua, F., Xuebin, H., Chenyang, J., et al. (2022) Intracardiac Echocardiography Chinese Expert Consensus. Frontiers in Cardiovascular Medicine, 9, Article ID: 1012731. [Google Scholar] [CrossRef] [PubMed]
[21] Nijssen, E.C., Rennenberg, R.J., Nelemans, P.J., Essers, B.A., Janssen, M.M., Vermeeren, M.A., et al. (2017) Prophylactic Hydration to Protect Renal Function from Intravascular Iodinated Contrast Material in Patients at High Risk of Contrast-Induced Nephropathy (AMACING): A Prospective, Randomised, Phase 3, Controlled, Open-Label, Non-Inferiority Trial. The Lancet, 389, 1312-1322. [Google Scholar] [CrossRef] [PubMed]
[22] Xu, W., Shou, X., Li, J., Yu, J., Zhang, Z., Yu, J., et al. (2018) Non-Fluoroscopic Percutaneous Transcatheter Closure of Atrial Septal Defects in Children under Transesophageal Echocardiographic Guidance. World Journal of Pediatrics, 14, 378-382. [Google Scholar] [CrossRef] [PubMed]
[23] Freitas-Ferraz, A.B., Bernier, M., Vaillancourt, R., Ugalde, P.A., Nicodème, F., Paradis, J., et al. (2020) Safety of Transesophageal Echocardiography to Guide Structural Cardiac Interventions. Journal of the American College of Cardiology, 75, 3164-3173. [Google Scholar] [CrossRef] [PubMed]
[24] Cao, Q., Zabal, C., Koenig, P., Sandhu, S. and Hijazi, Z.M. (2005) Initial Clinical Experience with Intracardiac Echocardiography in Guiding Transcatheter Closure of Perimembranous Ventricular Septal Defects: Feasibility and Comparison with Transesophageal Echocardiography. Catheterization and Cardiovascular Interventions, 66, 258-267. [Google Scholar] [CrossRef] [PubMed]
[25] Medford, B.A., Taggart, N.W., Cabalka, A.K., Cetta, F., Reeder, G.S., Hagler, D.J., et al. (2014) Intracardiac Echocardiography during Atrial Septal Defect and Patent Foramen Ovale Device Closure in Pediatric and Adolescent Patients. Journal of the American Society of Echocardiography, 27, 984-990. [Google Scholar] [CrossRef] [PubMed]
[26] Mullen, M.J., Dias, B.F., Walker, F., Siu, S.C., Benson, L.N. and McLaughlin, P.R. (2003) Intracardiac Echocardiography Guided Device Closure of Atrial Septal Defects. Journal of the American College of Cardiology, 41, 285-292. [Google Scholar] [CrossRef] [PubMed]
[27] Mullen, M.J., Hildick-Smith, D., De Giovanni, J.V., Duke, C., Hillis, W.S., Morrison, W.L., et al. (2006) Biostar Evaluation Study (Best): A Prospective, Multicenter, Phase I Clinical Trial to Evaluate the Feasibility, Efficacy, and Safety of the BioSTAR Bioabsorbable Septal Repair Implant for the Closure of Atrial-Level Shunts. Circulation, 114, 1962-1967. [Google Scholar] [CrossRef] [PubMed]
[28] Happel, C.M., Laser, K.T., Sigler, M., Kececioglu, D., Sandica, E. and Haas, N.A. (2015) Single Center Experience: Implantation Failures, Early, and Late Complications after Implantation of a Partially Biodegradable ASD/PFO‐Device (Biostar®). Catheterization and Cardiovascular Interventions, 85, 990-997. [Google Scholar] [CrossRef] [PubMed]
[29] Luo, H., Wang, J., Qiao, C., Zhang, X., Zhang, W. and Song, L. (2014) Evaluation of Different Minimally Invasive Techniques in the Surgical Treatment of Atrial Septal Defect. The Journal of Thoracic and Cardiovascular Surgery, 148, 188-193. [Google Scholar] [CrossRef] [PubMed]
[30] Hong, Z., Chen, Q., Lin, Z., Zhang, G., Chen, L., Zhang, Q., et al. (2018) Surgical Repair via Submammary Thoracotomy, Right Axillary Thoracotomy and Median Sternotomy for Ventricular Septal Defects. Journal of Cardiothoracic Surgery, 13, Article No. 47. [Google Scholar] [CrossRef] [PubMed]
[31] Luo, Z., Chen, Q., Yu, L., Chen, L. and Huang, Z. (2020) Comparative Study between Surgical Repair of Atrial Septal Defect via Median Sternotomy, Right Submammary Thoracotomy, and Right Vertical Infra-Axillary Thoracotomy. Brazilian Journal of Cardiovascular Surgery, 35, 285-290. [Google Scholar] [CrossRef] [PubMed]
[32] Li, S., Tang, S., Tong, Q., Yang, Y., Yang, L., Li, S., et al. (2014) Nuss Repair of Pectus Excavatum after Surgery for Congenital Heart Disease: Experience from a Single Institution. The Journal of Thoracic and Cardiovascular Surgery, 148, 657-661. [Google Scholar] [CrossRef] [PubMed]
[33] Crawford, G.B., Brindis, R.G., Krucoff, M.W., Mansalis, B.P. and Carroll, J.D. (2012) Percutaneous Atrial Septal Occluder Devices and Cardiac Erosion: A Review of the Literature. Catheterization and Cardiovascular Interventions, 80, 157-167. [Google Scholar] [CrossRef] [PubMed]
[34] Amin, Z. (2014) Echocardiographic Predictors of Cardiac Erosion after Amplatzer Septal Occluder Placement. Catheterization and Cardiovascular Interventions, 83, 84-92. [Google Scholar] [CrossRef] [PubMed]
[35] Podnar, T., Martanovič, P., Gavora, P. and Masura, J. (2001) Morphological Variations of Secundum‐Type Atrial Septal Defects: Feasibility for Percutaneous Closure Using Amplatzer Septal Occluders. Catheterization and Cardiovascular Interventions, 53, 386-391. [Google Scholar] [CrossRef] [PubMed]
[36] Amin, Z., Hijazi, Z.M., Bass, J.L., Cheatham, J.P., Hellenbrand, W.E. and Kleinman, C.S. (2004) Erosion of Amplatzer Septal Occluder Device after Closure of Secundum Atrial Septal Defects: Review of Registry of Complications and Recommendations to Minimize Future Risk. Catheterization and Cardiovascular Interventions, 63, 496-502. [Google Scholar] [CrossRef] [PubMed]
[37] Divekar, A., Gaamangwe, T., Shaikh, N., Raabe, M. and Ducas, J. (2005) Cardiac Perforation after Device Closure of Atrial Septal Defects with the Amplatzer Septal Occluder. Journal of the American College of Cardiology, 45, 1213-1218. [Google Scholar] [CrossRef] [PubMed]
[38] Butera, G., Romagnoli, E., Carminati, M., Chessa, M., Piazza, L., Negura, D., et al. (2008) Treatment of Isolated Secundum Atrial Septal Defects: Impact of Age and Defect Morphology in 1,013 Consecutive Patients. American Heart Journal, 156, 706-712. [Google Scholar] [CrossRef] [PubMed]
[39] Petit, C.J., Justino, H., Pignatelli, R.H., Crystal, M.A., Payne, W.A. and Ing, F.F. (2012) Percutaneous Atrial Septal Defect Closure in Infants and Toddlers: Predictors of Success. Pediatric Cardiology, 34, 220-225. [Google Scholar] [CrossRef] [PubMed]
[40] O’Byrne, M.L., Glatz, A.C., Sunderji, S., Mathew, A.E., Goldberg, D.J., Dori, Y., et al. (2014) Prevalence of Deficient Retro-Aortic Rim and Its Effects on Outcomes in Device Closure of Atrial Septal Defects. Pediatric Cardiology, 35, 1181-1190. [Google Scholar] [CrossRef] [PubMed]
[41] Loulmet, D., Carpentier, A., d’Attellis, N., Berrebi, A., Cardon, C., Ponzio, O., et al. (1999) Endoscopic Coronary Artery Bypass Grafting with the Aid of Robotic Assisted Instruments. The Journal of Thoracic and Cardiovascular Surgery, 118, 4-10. [Google Scholar] [CrossRef] [PubMed]
[42] Senay, S., Gullu, A.U., Kocyigit, M., Degirmencioglu, A., Karabulut, H. and Alhan, C. (2014) Robotic Atrial Septal Defect Closure. Multimedia Manual of Cardio-Thoracic Surgery, 2014, mmu014. [Google Scholar] [CrossRef] [PubMed]
[43] Ng, A.T. and Tam, P. (2014) Current Status of Robot-Assisted Surgery. Hong Kong Medical Journal, 20, 241-250. [Google Scholar] [CrossRef] [PubMed]
[44] Güllü, A.Ü., Şenay, Ş., Ersin, E., Demirhisar, Ö., Kocyigit, M. and Alhan, C. (2020) Feasibility of Robotic‐Assisted Atrial Septal Defect Repair in a 6‐Year‐Old Patient. The International Journal of Medical Robotics and Computer Assisted Surgery, 17, e2185. [Google Scholar] [CrossRef] [PubMed]
[45] Xiao, C., Gao, C., Yang, M., Wang, G., Wu, Y., Wang, J., et al. (2014) Totally Robotic Atrial Septal Defect Closure: 7-Year Single-Institution Experience and Follow-Up. Interactive CardioVascular and Thoracic Surgery, 19, 933-937. [Google Scholar] [CrossRef] [PubMed]
[46] Kim, K., Kim, Y.S., Kim, H.R., Kim, H.J., Yoo, J.S., Kim, J.B., et al. (2024) Robotic Repair of Atrial Septal Defect: Pre-Groove Vertical Right Atriotomy Approach. JTCVS Techniques, 28, 73-81. [Google Scholar] [CrossRef] [PubMed]
[47] Wang, S., Li, Z., Wang, Y., Zhao, T., Mo, X., Fan, T., et al. (2023) Transcatheter Closure of Perimembranous Ventricular Septal Defect Using a Novel Fully Bioabsorbable Occluder: Multicenter Randomized Controlled Trial. Science Bulletin, 68, 1051-1059. [Google Scholar] [CrossRef] [PubMed]
[48] Van den Branden, B.J., Post, M.C., Plokker, H.W., ten Berg, J.M. and Suttorp, M.J. (2010) Patent Foramen Ovale Closure Using a Bioabsorbable Closure Device: Safety and Efficacy at 6-Month Follow-Up. JACC: Cardiovascular Interventions, 3, 968-973. [Google Scholar] [CrossRef] [PubMed]

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