介入治疗34例膜部室间隔缺损  

Transcatheter closure of 34 cases with perimembranous ventricular septal defect

作　　者：靳有鹏[1] 王玉林[1] 韩波[1] 刘继英[1] 刘廷亮[1] 张建军[1] 庄建新[1] 韩秀珍[1] 汪翼[1] 公培娟[1] 

机构地区：[1]山东大学山东省立医院,山东济南250021

出　　处：《医学影像学杂志》2004年第12期987-990,共4页Journal of Medical Imaging

基　　金：山东省科技厅立项课题 (2 0 0 1BB1DBA2 )

摘　　要：目的 :评价介入治疗膜部室间隔缺损的临床效果。方法 :经胸超声心动图及临床表现诊断为膜部室间隔缺损的患者 34例 ,在局部或全身麻醉下行经导管室间隔缺损的介入治疗 ,其中 31例应用Amplatzer不对称型膜部室间隔缺损封堵器 ,3例应用国产室间隔缺损封堵器。术中连续经胸超声心动图和X线监测 ,术后 1天、1月、3月、6月行心电图及超声心动图复查。结果 :超声测定膜部室间隔缺损直径为 3 0～ 11 6mm(平均 4 5mm) ,距离主动脉右冠瓣 2 7～ 7 8mm(平均3 6mm) ,左心室造影测定膜部室间隔缺损的直径为 3 0～ 8 8mm(平均 5 4mm) ,所选膜部室间隔缺损封堵器直径为 4 0～16mm(平均 7 9mm)。技术成功率 10 0 %。超声心动图示术后即刻残余分流为 17 6 % (6 / 34) ,2 4h后残余分流为 8 8% (3/34) ,1个月后残余分流为 5 9% (2 / 34)。 34例患者术中均有一过性室性心律失常 ,1例发生一过性心跳骤停。术后 1例出现股静脉血栓形成 ,3例出现了一过性Ⅲ度房室传导阻滞 ,2例于术后 2 4h内发生溶血 ,经内科治疗后完全恢复 ,未见封堵器脱落、主动脉瓣返流等并发症。结论 :经导管关闭膜部室间隔缺损的操作简单、方便、并发症少 ,残余分流少见 ,值得在临床全面推广。Objective:To evaluate the effect of transcatheter closure of perimembranous ventricular septal defect (PMVSD).Methods: 34 patients with ventricular septal defect (VSD) diagnosed by clinical manifestation and echocardiography,received interventional therapy.31 VSDs were closed with Amplatzer asymmetric ventricular septal defect occluder (AAVSDO), while the other 3 VSDs with ventricular septal defect occluder made in China. Transthoratic echocardiography (TTE) and X-ray were used continuously to monitor the procedure. Transthoratic echocardiography was performed immediately after the release of devices, 24 hours, 1 month, 3 months and 6 months after the procedure, respectively.Results: The mean diameter of VSDs measured by echocardiography was 4.5mm (3.0～11.6mm), and while that by angiography was 5.4mm (3.0～8.8mm). The mean size of the occluder was 7.9mm (4～16mm) .The successful rate of device implantation was 100% (34/34). The residual shunt immediately after closure was 17.6%, whereas after 24 hours it was only 8.8%. After 1 month follow-up, only 5.9% trivial residual shunt existed. Ventricular tachycardia, which was considered relate to catheter manipulation inside the chamber of ventricle, was common and transient. Heart block was happened with one case during the operation and disappeared immediately after medical therapy. After operation, thrombosis was observed in one patient, 3 patients developed transient Ⅲ degree of A-V block, and hemolysis was observed in 2 patients which was disappeared several days after medical therapy.Conclusion:Transcatheter closure of PMVSD is safe and efficacious. Further studies are required to document its long term results in a larger patients population.

关 键 词：室间隔缺损 膜部 介入术 治疗 

分 类 号：R540.46[医药卫生—心血管疾病] R815[医药卫生—内科学]