膜周室间隔缺损封堵术后危险因素评价  

Risk Factors for Arrhythmia after Transcatheter Closure of Perimembranous Ventricular Septal Defects

作　　者：林彬 冯德广[1] 余海彬[1] 徐成阳[1] 于海明[1] 

机构地区：[1]郑州大学第二附属医院心血管外科,郑州市450014

出　　处：《医药论坛杂志》2008年第1期8-10,共3页Journal of Medical Forum

摘　　要：目的评价经导管室间隔缺损封堵术介入治疗膜周部室间隔缺损术后早期心律失常及其危险因素。方法2004年6月-2006年6月，50例膜周部室间隔损患者接受了经导管应用Amplatzer装置进行堵塞。男27例，妇23例；平均年龄（13、5±4．0）岁（5～20岁）。其中1例合并主动脉窦窦瘤，1例为外科修补术后残余漏。经胸超声心动图（TTE）提示，VSD的平均直径（5．2±0．9）mm（3～10mm）。所有患儿在X线透视及超声监测下通过建立股动脉轨道，经右心系统释放封堵器。结果50例患儿封堵器置入成功，技术成功率为100％。9例术后7d内发生了不同类型的传导阻滞，发生率为18．8％，分别为Ⅰ°房室传导阻滞1例，Ⅲ°房室传导阻滞1例，左前分支阻滞4例，不完全性右束支传导阻滞3例，完全性右束支传导阻滞3例，其中3例并发两种传导阻滞。分析本组心律失常的影响因素，发现：①室间隔缺损上缘距主动脉右冠瓣距离〈2mm；②室间隔缺损直径≥7mm，封堵器直径≥9mm等与心律失常密切相关。结论心律失常是膜周部室间隔缺损封堵术后早期严重的并发症；严格选择手术适应证是降低膜周部室间隔缺损介入封堵术后心律失常发生率的有效措施。Objective To analyze the risk factors resulting in arrhythmias after transcatheter closure of Perimembranous Ventricular septal defects （PMVSDs） in patients to decrease the incidence of arrhythmias after the interventional catheterization. Methods From June 2004 to June 2006, fifty patients（27 males and 23 females）with perimembranous ventricular septal defect（VSD） , underwent an attempt of transcatheter closure using the amplatzer specially designed for perimembrenous VSD. Among the 50 patients, one of them was diagnosed with aneurysm of aortic sinus, and one with leakage after the surgical repair of VSD. The mean age of patienst was （ 13.5±4.0） years（ ranged from 5 to 20 years）. The mean diameter of VSD measured by transthoracic echocradiograhy （ TIE ） was （ 5.2 ±0.9 ） mm （ ranged from 3 to 10mm）. Occluder was released through the right heart system. Follow - up was performed based on the echocardiography and ECG. Results The devices were deployed successfully in 48 patients,the rate of success was 100%. 9 cases（ 18. 8% ） developed various block of heart conduc- tion within 7 days, which included first degree atrioventricular block in 1 patients, complete atrioventricular block in 1, left anterior fascicular block in 1,incomplete right bundle branch block in 3, complete right bundle branch block in 3, and 3 patients had two kinds of hearts block. It was found that the distanee from upper margin of defects to the aortic valve 〈 2mm, the diameter of ventricular septal defects〉 7mm,the diameter of device ≥9mm, ect, were independent predictors of postclosure arrhythmias. Conclusion Arrhythmias remain the severe early complications after interventional catheterization for PMVSDs in patients. Strict selection of indications may be the most effective measures to prevent arryhthmias after transcatheter closure of PMVSDs in patients.

关 键 词：室间隔缺损 心律失常 气囊扩张术 随访研究 

分 类 号：R654.2[医药卫生—外科学]