国产封堵器经导管治疗室间隔缺损并发轻度主动脉瓣脱垂的临床研究  

Transcatheter closure of ventricular septal defects associated with aortic valve prolapse using the China-made occluder

作　　者：马东江[1] 张玉顺[1] 代政学[2] 李寰[2] 吴栋梁 刘平 和旭梅[1] 

机构地区：[1]西安交通大学医学院第一附属医院先心周围血管病中心,710061 [2]第四军医大学西京医院心血管内科 [3]陕西省咸阳市中铁二十局同景医院心脏中心

出　　处：《中国医师进修杂志（内科版）》2007年第2期17-19,25,共4页Chinese Journal of Postgraduates of Medicine

基　　金：陕西省自然科学基金赞助项目（2003C2053）

摘　　要：目的评价室间隔缺损（VSD）并发轻度主动脉瓣脱垂经导管治疗的可行性，并对国产封堵器的疗效进行评价。方法47例VSD并发轻度主动脉瓣脱垂患者，均使用国产封堵器行介入治疗，同时行超声心动图检查追踪测量及随访。结果38例封堵成功。9例术中封堵后发生少～中量主动脉瓣返流而放弃封堵。VSD术前超声测量缺损直径为3．2—16．4mm，术中左心室造影测量缺损直径为33～17．1mm，植入的封堵器腰部直径为6．0—22．0mm。共植入国产封堵器38个，技术成功率为100．O％，手术成功率为80．9％。封堵器到位后即刻左心室和升主动脉造影显示：微一少量残余分流6例；微量主动脉瓣返流7例。1例嵴内型VSD术后1个月超声心动图检查发现封堵器移位。发生中量残余分流；其余37例术后3个月超声心动图复查3例微鼎主动脉瓣返流，均无残余分流。术后发生高度房室传导阻滞（AVB）2例，经植入临时起搏器及药物治疗后恢复。结论国产封堵器经导管治疗并发轻度主动脉瓣脱垂的VSD确实可行，近、中期临床疗效确切，是一种安全、可靠的治疗方法：但其远期疗效尚需长期临床观察。Objective To evaluate the feasibility, safety and efficiency of transcatheter closure of ventricular septal defects （VSD） associated with aortic valve prolapse using the China-made occluder devices. Methods Forty-seven patients with VSD underwent attempted transcatheter closure of a VSD using the China-made occluder devices at a median age of（ 11.3 ± 8.5）years, including 26 cases who were membranous VSD among 18 cases VSD with membranous ventriculax septal aneurysm, 17 cases with intercristal VSD and 4 cases with hypocristal VSD. Among them 33 cases associated with light aortic fight valve prolapse, 8 cases with aortic noncoronary valve prolapse, 6 cases with the aortic right and noncoronary valve prolapse. All patients were transcathetered by the China-made occluder devices and at the same time were followed by transthoracic echocardiography to evaluate the efficiency. Results Thirty-eighty cases were successfully implanted with success implant rate of 80.9%, and 9 cases were retracted due to small to moderate aortic insufficiency after the implant of occluder devices. The size of defects were 3.2-16.4 mm which were measured by transthoracic echocaxdiography. But the size of defects were 3,3-17.1 mm which were measured by left ventriculography. The selected diameter of occluder devices were 6.0-22.0 mm. The left ventricular graphics （LVG） and ascending aortographies showed that 6 cases had a trace to small residual shunt and 7 cases associated with trace aortic insufficiency immediately after the procedures. In 1 case with intercristal VSD, occluder displace and moderate residual shunt were detected by transthoracic echocardiography at 1 month follow up. In the rest of patients, only 3 cases had trace aortic insufficiency and no suffered with residual shunt at 3 months follow up.Two cases suffered with temporary advanced atrial ventriculax block and returned to normal after medicines treatment. Conclusions Transcatheter closure of ventricular septal defects associated with light aortic valve prolaps

关 键 词：室间隔缺损 主动脉瓣脱垂 封堵器 

分 类 号：R654.2[医药卫生—外科学]