儿童膜周部室间隔缺损介入治疗的临床研究  

Transcatheter closure of perimembranous ventricular septal defects with Amplatzer device:initial clinical applications in children

作　　者：钱明阳[1] 冯建章[1] 李渝芬[1] 王慧深[1] 张智伟[1] 王树水[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所儿科,广州510100

出　　处：《岭南心血管病杂志》2006年第6期388-391,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的总结应用Amplatzer膜部室间隔缺损封堵器膜部介入治疗室间隔缺损的适应证、操作方法以及并发症的防治。方法收集儿科膜周部室间隔缺损202例,男115例,女87例,年龄(6.4±3.6)岁,体重(22±10)kg。选用Amplatzer膜部室间隔缺损封堵器。术前行心血管造影测量室间隔缺损直径、类型、部位,包括是否有膜部瘤缺损、缺损口到主动脉瓣的距离。结合三维超声定量,确定适应证,建立股动脉-室间隔-股静脉轨道,在超声的配合下,进行封堵术。结果202例患儿,左心室造影显示不符合适应证12例,失败6例,成功封堵184例(成功率96.8%);肺循环/体循环分流量1.8±0.6;左心室造影显示缺损口大小(4.8±2.3)mm,与主动脉瓣距离(4.4±1.9)mm;输送长鞘(7.3±0.6)F;封堵器型号(7.2±2.6)mm;建立轨道时间(27.2±8.3)min;手术时间(86±21)min;X线透视时间(12.1±3.7)min;住院时间(8.7±2.2)d;合并症:即刻残余分流33例,主动脉瓣反流2例,轻度溶血2例,Ⅲ度房室传导阻滞1例,左前半传导阻滞6例,完全性右束支传导阻滞8例及不完全性右束支传导阻滞22例;3～24个月随诊结果:不完全性右束支传导阻滞12例,完全性右束支传导阻滞4例,左前半传导阻滞1例,电轴左偏或左心室高电压6例。结论经导管Amplatzer膜周部室间隔缺损封堵术安全可行,成功率高,残余分流低,并发症较少,近期效果良好。Objectives To evaluate the feasibility and efficacy of transcatheter closure of perimembranous ventricular septal defects(PVSD) using the new Amplatzer membranous ventricular septal defect(VSD) occluder.Methods From June 2003 to Dec.2005,202 children(115 males,87 females) with PVSD underwent an attempt of catheter closure using a new device specifically designed for the membranous septum.The mean age of patients was(6.4±3.6) years;the mean weight of patients was(22±10) kg.The procedures were performed under general endotracheal anesthesia in all patients.Routine right and left heart catheterization was performed to assess the degree of shunting and to evaluate the pulmonary vascular resistance.demonstrate the steps of closure by angiography and echocardiography(echo).Angiography in single plane(60°LAO/20°cranial) was performed to define the location and size of the VSD.This provided a stable arteriovenous loop and allowed a 7-8 Fr long delivery sheath positioned into the left ventricular(LV) apex.Monitored by echo,the device was deployed and LV angiography was performed.If the device had good position,then the device was released by counterclockwise rotation of the pin vise.The procedure was finished.Results The successful rate of the device implantation was 96.8%(184/202).Twelve of 202 cases were unsuitable to closure after angiography,and 6 cases were fail.The mean diameters of PVSDs measured by angiography was(4.8±2.2)mm.The mean size of the occluder was(7.2±2.6)mm.Qp/Qs was 1.5-2.6.The mean was(1.8±0.6);The procedure time was(86±21)min;The fluoroscopy was(12.1±3.7)min.The residual shunt immediately after the procedure was 14.6%(13/89),whereas after 24 hours it was only 2.2%.As 3-12 months following up,all cases had no residual shunt.Six cases occurred A-V block and bundle branch block.Conclusions The initial experience with the Amplatzer membranous VSD occluder for treatment of PVSDs suggests that it is a safe and effective device for transcatheter occlusion of PVSDs located in the thin portion of th

关 键 词：膜周部室间隔缺损 介入治疗 儿童 

分 类 号：R541.1[医药卫生—心血管疾病]