超声检查室间隔缺损封堵术并发症及原因分析  

Echocardiographic Findings on Complications and Causes of Transcatheter Closure of Ventricular Septal Defect

作　　者：李军[1] 张军[1] 李利[1] 朱霆[1] 田雪[1] 张玉顺[2] 左建[3] 

机构地区：[1]解放军第四军医大学西京医院超声诊断科,西安市710032 [2]解放军第四军医大学西京医院心内科,西安市710032 [3]解放军第四军医大学西京医院心血管外科,西安市710032

出　　处：《中国超声医学杂志》2006年第8期592-594,共3页Chinese Journal of Ultrasound in Medicine

基　　金：陕西省攻关课题(No.2005K12-G5(14);西京医院高新技术基金(No.XJGX0533M31)

摘　　要：目的探讨经导管室间隔缺损(Ventricular septal defect,VSD)封堵术出现的并发症及其原因,提高手术的疗效。方法使用HP Sonos1500及5500型彩色多普勒诊断仪对571例成功行VSD封堵术患者术前、术后即刻行超声心动图检测,术后5d、1、3、6、12个月随访。结果封堵即刻微量或少量残余分流31例,72h后7例,其中2例行外科手术,余随访除1例仍有少量分流外均消失。封堵术后即刻及3d18例、11例分别出现三尖瓣微量和少量反流,随访观察反流消失17例。3例最短术后4d、最长1个月三尖瓣前叶腱索断裂,出现中或大量反流。主动脉瓣微量及少量反流6例。术中及术后出现度房室传导阻滞者12例。1例因先天性脑血管畸形出现脑出血于封堵术后死亡。结论VSD封堵术并发症的原因与室间隔缺损形态及分流口多少、缺损残端距主动脉右冠瓣距离和封堵器移位有关。导管、输送杆传输不当及封堵器磨损可损伤腱索,封堵器刺激、压迫可导致房室传导阻滞。Objective To explore the complications induced by ventricular septal defect （VSD） occlusion and the possible causes in order to improve the curative effect. Methods A total of 571 consecutive patients with successfully occluded VSD underwent echocardiography. Philips Sonos 1500 and 5500 ultrasound systems were adopted before and immediately after occlusion and followed up at 5d, 1, 3, 6, and 12 months after occlusion. Results Minimal or trivial residual shunts were visualized on echocardiography in 31 cases after immediately occlusion and only in 7 cases 72 hours after the procedure. Two of the 7 patients were surgically treated. The residual shunts in the remaining patients disappeared except 1 patient who had a trivial residual shunt. Minimal tricuspid valve regurgitations （TR） were visualized in 18 patients and trivial TR in 11 patients immediately and 3 d after occlusion respectively. TR disappeared in 17 patients during following-up. Chordae tendineae were ruptured in 3 patients between the 4 d and 1 month after the procedure and moreover severe TR were detected. Trivial and mild aortic valvular regurgitations were found in 6 cases. During and after occlusion , twelve patients developed Ⅲ degree atrioventricular block. One patient died of intracranial bleeding due to congenital cerebral vessel malformation after occlusion. Conclusions The complications induced by VSD occlusion related with VSD shapes and dimensions, distances between VSD margin and aortic right valvular leaflet and occluder＇s displacement. Unsuitable transportation of catheter and guiding wire and damaged occluder might iniure the chordae tendineae. Ⅲ degree atrio-ventricular block might be derived from occluders and catheters stimulation and oppression.

关 键 词：超声心动图 室间隔缺损 封堵术 并发症 

分 类 号：R541.1[医药卫生—心血管疾病]