室间隔缺损介入治疗后并发封堵器移位的原因分析  

Analysis of occluder displace after transcatherter occlusion of ventricular septal defect

作　　者：张玉顺[1] 李寰[1] 代政学[1] 李军[1] 张军[1] 王晓燕[1] 

机构地区：[1]第四军医大学西京医院心血管内科,陕西西安710032

出　　处：《心脏杂志》2005年第2期172-174,共3页Chinese Heart Journal

基　　金：陕西省自然科学基金资料(项目编号:2003C2053)

摘　　要：目的探讨经导管介入治疗室间隔缺损(VSD)发生封堵器移位的原因和预防措施。方法介入治疗后封堵器移位患者4(男3,女1)例,3例为膜周部VSD伴膜部瘤,1例为嵴内型VSD,缺损直径分别为13、12、12和10mm,所选用的封堵器分别为16、12mm国产对称型膜部VSD封堵器,14mmAmplatzer膜部VSD封堵器和14mm国产偏心型膜部VSD封堵器。结果4例均一次性封堵成功。术后即刻均无残余分流。2例在术后4和12h分别发生溶血,超声心动图检查封堵器位置无明显变化,但均有明显残余分流。经药物治疗后,溶血恢复正常,残余分流消失。1例术后第4天,心电图检查为Ⅲ度房室传导阻滞,超声心动图发现封堵器明显向囊袋出口移位。转心脏外科手术取出封堵器并修补缺损,术后患者Ⅲ度AVB恢复。1例嵴内型VSD术后2周,超声心动图发现封堵器向右心室移位,有明显残余分流。随访4个月残余分流减少。结论VSD封堵治疗后,封堵器移位与缺损的病理解剖特性有关。多发生在伴有膜部瘤的膜部VSD和嵴内型VSD。AIM: To investingate the reasons of occluder displace and its preventive measures after transcatheter occlusion of ventricular septal defect (VSD). METHODS: 4 (3 male, 1 female) cases happened occluder displace after transcatheter occlusion of VSD. Of whom 3 cases were peri-membranous VSD with membranous ventricular septal aneurysm, 1 case was VSD. The diameter of defects were 13, 12, 12, and 10 mm, respectively. The implanting occluders were 16 mm, 12 mm domestic-made concentric VSD occluder, 14 mm Amplatzer VSD occluder, and 14 mm domestic-made eccentric VSD occluder, respectively. RESULTS: The four cases were all successfully implanted with once try, and had no residual shunt immediately after occlusion. 2 cases happened haemolysis in the 4 h and 12 h of post-occlusion, and both occluders position were not found significant change, but both had significant residual shunt. After treated with drugs, both haemolysis were recovery and residual shunt were disappeared. 1 case in the 4 d of post-occlusion, ECG found third-degree atrioventricular block and echocardiography found occluder obviously displaced to the outlet of membranous aneurysm. The case had to be transferred to surgically remove occluder and repair VSD, and third-degree atrioventricular block was recovered after surgery. 1 case with VSD, 2 weeks after occlusion, echocardiography found occluder was displaced to the right ventricular and had obviously residual shunt. 4 months follow-up, residual shunt examined by echocardiography was diminished. CONCLUSION: Transcatheter occlusion of VSD, occluder displace is associated with VSD pathological anatomy. Occluder displace mostly happened in the peri-membranous VSD with membranous ventricular septal aneurysm and VSD.

关 键 词：室间隔缺损 介入治疗 封堵器 

分 类 号：R541.1[医药卫生—心血管疾病]