国产双盘状封堵器治疗儿童膜周部室间隔缺损效果及随访研究  

The effect and follow-up study on transcatheter closure of ventricular septal defects using the homemade VSD occluder

作　　者：成胜权[1] 刘建平[1] 孙新[1] 李军[2] 刘丽文[2] 邓跃林[1] 李利[2] 朱永胜[2] 

机构地区：[1]第四军医大学西京医院儿科,西安710032 [2]第四军医大学西京医院超声室,西安710032

出　　处：《中国循证儿科杂志》2007年第1期27-31,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的探讨国产双盘状封堵器治疗儿童膜周部室间隔缺损（VSD）的效果及其随访。方法75例膜周部VSD患儿，年龄3～14岁，平均（8．5±3．6）岁，VSD直径为3．0～14．0mm，平均（6．54-3．6）mm，采用经导管植入国产双盘状封堵器，门诊随访，进行心脏听诊、超声心动图检查有无残余分流及封堵器位置。结果①74例封堵器植入成功，技术成功率98．7％，1例导管未能通过室间隔缺孔；②术后即刻左心室造影示：65例（87．8％，65／74）无残余分流，9例（12．2％，9／74）存在微量至少量残余分流，超声心动图示：68例（91．9％，68／74）无残余分流、6例（8．1％，6／74）存在微量至少量残余分流；2例封堵术后3d发生Ⅲ度房室传导阻滞，应用泼尼松及营养心肌药物治疗4～10d后消失。1例封堵术后24h发生溶血，经过7d内科保守治疗治愈；③术后1个月共随访73例患儿，超声心动图示：71例（97．3％，71／73）无残余分流、2例（2．7％，2／73）存在微量至少量残余分流；④术后3个月、6个月、1年、2年和3年，随访到的病例分别为70、68、21、15和12例，存在微量至少量残余分流的2例分别于3和6个月内残余分流消失。结论经导管植入国产双盘状封堵器治疗儿童膜周部VSD是一种安全有效的微创介入治疗方法，操作简便，成功率高，近期和远期疗效可靠。Objective Congenital heart disease （CHD） is the most popular cardiovascular disease of paediatrics. Ventricular septal defect （VSD） accounts for 50%. This study was to evaluate the treatment efficiency of transcatheter closure of ventricular septal defect （ VSD ） using the homemade occluder device. Methods Seventy-five patients with VSD underwent attempted transcatheter closure using the homemade occluder device at a median age of 8.5 years old （ ranging from 3.0 to 14）. The mean VSD diameter at its left ventricular side was 6. 5 ± 3.6mm （ ranging from 3.0 to 14.0）. The left ventricular graphies （LVG） were performed to evaluate the closure results immediately after the operation. Echocardiography and ECG were performed 1 day and 1 month respectively after the closure to find whether there was residual shunt or recanalization. Results ①The technical success rate of the group was 98.7%. ②LVG showed that 65（87.8% ） patients had complete closure immediately after the operation, 9（ 12. 2% ） had a trivial to small shunt immediately after the operation. Within 24 -48 h, color Doppler revealed complete closure in 74 patients（98.7% ） and a trivial to small shunt in 2 patients（2. 3% ）. Two cases had Ⅲ°atrial ventricular block and returned to normal after 4 - 10 days with medical treatment. One patient developed hemolysis 24h after the operation and recovered after 7 days with medical treatment. ③ Echocardiography revealed complete closure in 71 patients（94. 7% ） and a trivial to small shunt in 2 patients（2. 7% ） 1 month after the operation. ④ There were 70, 68, 21, 15 ,and 12 patients who were followed up 3 months, 6 months, 1 year, 2 years, and 3 years after the operation, respectively. Two cases who had a trivial to small shunt recovered after 3 months and 6 months respectively. Conclusions Transcatheter method of VSD occlusion using homemade VSD occluder is safe and effective. It had a high technical success rate, satisfied and reliable immediate and short-term

关 键 词：儿童 室间隔缺损 介入治疗 

分 类 号：R725.4[医药卫生—儿科]