经胸超声指引下经导管关闭儿童膜周部室间隔缺损  

Transcatheter closure of perimembranous ventricular septal defects in children following transthoracic echocardiography

作　　者：解春红[1] 夏呈森[1] 周银宝[1] 龚方戚[1] 蒋国平[1] 朱卫华[1] 赵正言[1] 

机构地区：[1]浙江大学医学院附属儿童医院,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2006年第6期662-667,共6页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的：探讨儿童膜周部室间隔缺损（ventricular septal defects，VSD）经导管介入治疗的安全性和临床疗效。方法：2002年9月至2005年12月，共89例膜周部室间隔缺损患儿接受了经导管介入治疗。男47例，女42例；平均年龄（6．4±3．9）岁（1～18岁），体重（22±11）kg（9～78kg）。其中1例合并动脉导管未闭，6例为外科术后VSD残余瘘（3例为法洛四联症术后VSD残余瘘，3例为VSD术后残余瘘）。经胸超声心动图（transthoracic echocardiography，TTE）提示，VSD的平均直径（4．3±1．5）mm（2～8．5mm）。所有患儿在X线透视及经胸超声监测下通过建立股动静脉轨道，经右心系统释放封堵器，并分别于术后1、3、6、12个月进行超声心动图、心电图、X线片随访评价。结果：85例患儿封堵器置入成功，技术成功率为95．5％。无死亡病例。术后即刻超声及造影显示，微量残余分流12例，9例微量残余分流于术后24h复查超声时消失，3例微量残余分流于术后6个月复查超声时消失。1例发生严重心律失常致抽搐，2例发生溶血，2例完全性左束支传导阻滞，1例左前分支传导阻滞，3例不完全性右束支传导阻滞。经激素治疗3～7d后均恢复正常。患儿接受了平均9个月的随访（1～36个月），随访中无封堵器移位，无瓣膜损伤等并发症。结论：经导管介入方法关闭儿童膜周部室间隔缺损具有较高的安全性，近期效果良好。经胸超声心动图在指引小儿VSD介入封堵中可避免全身麻醉和气管插管，缩短手术时间，是完全可行和安全的。Objective： To evaluate the efficacy and safety of transcatheter closure of perimembranous ventricular septal defects （VSD） in children following transthoracic echocardiography （TTE）. Methods： From September 2002 to December 2005, eighty-nine children （47 males and 42 females） with perimembranous （VSD） underwent an attempt of transcatheter interventional occlusion. Among the 89 children, one of them was diagnosed with patent ductus arterious （PDA） and six with VSD leakage after the surgical repair （three with leakage after the surgical repair of tetralogy of Fallot and three with leakage after the surgical repair of VSD）. The mean age of patients was （6.4±3.9） years （ranged from 1 to 18 years）. The mean body weight of patients was（22±11）kg （ranged from 9 to 78 kg）. The mean diameter of VSD measured by TTE was （4.3±1.5）mm（ranged from 2 to 8.5mm）. The path of artery to vein was established following X-rays and TTE. Occluder was released through the right heart system. All patients were followed up in 1, 3, 6 and 12 months after procedure of TTE, X-ray and electrocardiography. Results： The devices were deployed successfully in 85 patients, the rate of success was 95.5%. No death occurred during and after the procedure. There was trivial residual shunt in 12 patients immediately after the closure by TTE and angiography. Twenty-four hours later, only 3 patients had trivial residual and no shunt existed after 6 months follow-up. Convulsion occurred in 1 case due to serious cardiac arrhythmias. Hemolysis was found in 2 cases. Other complications included 2 cases of complete left bundle branch block, 1 cases of left anterior fascicular block and 3 cases of incomplete right bundle branch block. They recovered after 3 to 7 days of corticosteroid treatment. After 1 to 36 months （mean 9 months） follow-up, none of occluders displacement occurred and no valve was involved. Conclusion： Transcatheter closure of membranous VSD using occluder would be safe and effective

关 键 词：室间隔缺损/治疗 心脏导管插入术 动脉导管未闭/治疗 膜周部室间隔缺损 封堵器 

分 类 号：R726.5[医药卫生—儿科]