经导管治疗假性室间隔膜部瘤226例临床分析  

A clinical results of 226 cases transcatheter closure of pseudoaneurysm of the perimembranous ventricular septal defect

作　　者：王震[1] 解启莲[1] 张密林[1] 甄宇治[1] 谭慧莲[1] 刘凌[1] 尤扬[1] 额尔敦高娃[1] 高磊[1] 张源祥[1] 

机构地区：[1]河北医科大学第一医院先天性心脏病诊疗中心,石家庄050031

出　　处：《临床心血管病杂志》2006年第2期88-90,共3页Journal of Clinical Cardiology

摘　　要：目的：评价经导管介入治疗假性室间隔膜部瘤的可行性及安全性，并总结其技术难点与临床策略。方法：226例先天性室间隔缺损伴膜部瘤形成患者，超声测量室间隔缺损直径3～15（4．25±2．71）mm，左心室造影测量室间隔缺损直径2～16（4．37±2．84）mm。应用7～10F输送鞘管从右心系统送入相应封堵器。封堵器直径为4～18（6．24±2．48）mm，封堵后15min重复左心室造影和经胸心脏超声波检查，观察封堵的即刻效果。术后连续心电监护5d。术后1、3个月定期心电图、心脏超声检查。结果：226例中220例患者封堵成功，成功率97．3％。未成功的6例中，4例因多出口囊袋状膜部瘤不能完全封堵而建议外科手术，1例因封堵器放置后影响主动脉瓣关闭，1例因严重心律失常而放弃封堵治疗。206例术后15min左心室造影、经胸心脏超声检查显示完全封堵，14例术后造影示少量分流，1～3个月后超声复查无异常分流。术中并发左、右束支传导阻滞分别为8例和12例，均为一过性，1周内恢复。X线透视日寸问10～65（15．2±8．8）min，操作时间35～120（42．5±16．2）min。结论：经导管采用封堵器治疗假性室间隔膜部瘤疗效好，安全性高，并发症少，临床应用前景好。技术关键在于对膜部瘤形态的判断以及封堵器的选择。Objective：To evaluate the feasibility and satery of transcatheter closure of pseudoaneurysm of the perimembranous ventricular septal with perimembranous ventricular septal defect（VSD） occluder, and to summarize the technological difficulty and clinical strategy. Method：Thanscatheter closure was attempted in 226 patients with pseudoaneurysm of the perimembranous ventricular septal, The diameter of VSD measured by echoeardiography were 3 to 15 min, mean（4.25±2.71）mm. The angiographic diameter of the VSD were 2 to 16mm,mean （4.37±2.84）mm. A7-10F delivery sheath was advanced aross the perimembranous VSD over awire from femoraral vein to deploy the oecluder under the guidance of echocardiography and fluoroscopy. The device diameter se lected was from 4 to 18 mm, mean （6.24 ± 2.48）mm, Left ventriculography and transthoracic eehocardiography were repeated to assess the effect of closure 15 min after the procedure. Continuous electrocardiogram monitoring lasted for 5 days, The echocardiography and electrocardiogram examination were scheduled for 1 and 3 months of follow up. Result. The occluders were successfully deployed in 220 patients. There were six procedural failures, four cases with more holer pseudoaneurysm can not to be close completely, one with device related aortic insufficiency, and one with severe cadiac arrhythmia. After deployment of the devices, there was no residual shunt in 206 of 226 patients, 14 patients with trivial residual shunt that disappeared after one to three months. 12 patients developed transient complete right bundle branch block and 8 transient complete left bundle branch block disappeared in one week. The fluoroscopy time for the procedure was （15.2±8.8） min （range from 10 to 65 min）. The procedure time was （42.5 ± 16.2） min（ range 35 to 120 min）. Conclusion： Transcather closure of membranous ventricular septal defect oloecluderis is effective, easy and safe. The key of technology is judgment for morphology of pseudoaneurysm and selection of occ

关 键 词：经导管封堵 室间隔缺损 假性室间隔膜部瘤 

分 类 号：R654.23[医药卫生—外科学]