应用新型Amplatzer膜部室缺堵闭器关闭儿童膜周室间隔缺损的临床研究  

Thrascatheter closure of permembranous ventricular septal defect using asymmetric membranous VSD Amplatzer device in children

作　　者：何健峰[1] 高伟[2] 周爱卿[2] 余志庆[2] 孙琨[2] 张玉奇[2] 田杰[1] 钱永如[1] 白永虹[1] 

机构地区：[1]重庆医科大学附属儿童医院 [2]上海第二医科大学附属新华医院,上海儿童医学中心心内科

出　　处：《介入放射学杂志》2004年第S2期120-123,共4页Journal of Interventional Radiology

摘　　要：目的　探讨经导管采用新型Amplatzer膜部室缺堵闭器关闭儿童膜周室缺的安全性及可行性。方法　 2 0 0 2年 6月～ 2 0 0 4年 7月 32例膜周部室间隔缺损的患儿接受经导管采用新型Amplatzer膜部室缺堵闭器的介入治疗 ,年龄 3～ 15岁 ,平均 (6 .1± 2 .8)岁 ,体重 12～ 31kg(18.9± 5 .1kg) ,所有病例术前检查证实为膜周部室间隔缺损 (PVSD) ,缺损大小 (8.91± 2 .2 6 )mm(4～ 13mm) ,分流口大小 (3.3±1.1)mm(2 .3～ 7.0mm) ,距离主动脉瓣 (4 .2 1± 2 .10 )mm(0 .5～ 8mm) ,有假性室隔瘤形成 7例 (其中 2个及以上分流口 2例 ) ,部分右房室瓣组织附着 19例。术后定期行TTE及临床检查随访。结果　本组封堵技术成功率 10 0 % ,堵塞后即刻完全封堵率 90 .6 % ,术后 6个月完全封堵率 96 .9% ,仅 1例存在无血流动力学改变的少许残余分流。除术中有一过性房性、室性早博 ,室性心动过速 ,房室传导阻滞 ,束支传导阻滞 ,无一例发生Ⅲ°AVB ,栓塞 ,溶血 ,封堵器脱落 ,心内膜炎等并发症 ,仅 2例 (6 .3% )有轻微主动脉返流 ,2例有轻度右房室瓣返流 ,术后病理生理及血流动力学有明显改善 ,LVDd、LVDs、LA术后明显缩小 ,MPA流速、MV流速术后明显减慢。随访时间 6个月至 1年零 10个月。结论　经导管采用新型Amplatzer膜部?Objective To evaluate the safety and efficacy of thrascatheter closure of permembranous ventricular septal defect(PVSD) using asymmetric membranous VSD Amplatzer occluder device (AAOD) in children.Methods From June in 2002 to July in 2004,Thrascatheter closure of PVSD with AAOD was performed in 32 cases.Age 3～15 years(mean 6.1±2.8years),weight 12～31 kg(mean 18.9±5.1 kg).They are all met with criteria for transcatheter closure received this operation.The average PVSDs diameter were 8.91±2.26 mm(range 4～13 mm),The cent flows diameter were 3.3±1.06 mm(range 2.3～7 mm), and the distance of upper rim in PVSDs to aortic valve the average diameter 4.21±2.10 mm(range 0.5～8 mm). Seven patients have aneurysm of membranous septal, with multiple fenestrate aneurysm of membranous septal in 2 cases. Nineteen patients have PVSD adhesive to tricuspid septal valve.Follow up with echocardiography and clinical examination. Results The successful rate of technique was for 100% in this group. The immediate,six month complete occlusion rate were 90.6%(29/32),96.9%(31/32).A trivial hemodynamic insignificant shunt remained in 1 case.No complication(include hemolysis,device embolization,embolism, Ⅲ°AVB,bacterial arteritis,etc)occurred except transient atrial and ventricular premature beats, ventricular tachycardia,A-V block and bundle branch block. Two patient continued to have trace aortic regurgitation. Two patient continued to have mild tricuspid regurgitation.The hemodynamic significant improved after thrascatheter closure of PVSD, The median LVDd、LVDs、LA and the velocity of flow MPA、MV decreased. The total follow up was six month to ten month and one years.Conclusions Transcatheter occlusion of permembranous ventricular septal defect(PVSD) using asymmetric membranous VSD Amplatzer occluder device (AAOD)in children was an excellently safe, efficient and feasible nonsurgical method. Further clinical trials are underway to assess the long-term safety and results.

关 键 词：经导管封堵 膜周部室间隔缺损 新型Amplatzer膜部室缺堵闭器 

分 类 号：R725.4[医药卫生—儿科]