小儿室间隔缺损介入治疗失败原因分析  

ANALYSIS OF THE REASON FOR THE FAILURE OF INTERVENTIONAL TREATMENT IN CHILDREN'S VENTRICULAR SEPTAL DEFECT

作　　者：高虹[1] 董少红[1] 张智伟[2] 罗林杰[1] 石继军[2] 李渝芬[2] 陈科奇[1] 王树水[2] 李俊杰[2] 

机构地区：[1]暨南大学第二临床医院,广东深圳518020 [2]广东省人民医院心研所,广东广州510100

出　　处：《现代医院》2009年第9期21-22,共2页Modern Hospitals

摘　　要：目的探讨经导管室间隔缺损封堵术(TCVSD)介入治疗失败原因及防治措施。方法对2005年1月～2008年12月620例经TCVSD治疗中失败的50例病案资料进行回顾性分析。结合左心室、主动脉造影及经胸超声心动图(TTE)检查,综合分析介入治疗失败原因。结果全组介入治疗失败发生率8%(50/620)。无膜部瘤破裂,无封堵器移位、脱落,无持续溶血。16例合并明显主动脉瓣脱垂,8出现放置后中度以上主动脉瓣返流。因反复出现完全性左、右束支阻滞停止手术4例,释放封堵器后出现完全性左、右束支阻滞及Ⅲ°房室传导阻滞收回封堵器3例,术后出现无法恢复的Ⅲ°房室传导阻滞而外科取出封堵器3例。4例出现三尖瓣返流加重。4例肌部VSD失败病例中,2例建轨困难,2例分流量小于2mm。1例死亡病例,死亡原因为蛛网膜下腔出血。结论TCVSD是安全有效的治疗方法。严格掌握适应症,结合多种检查方法,采用正确的封堵策略,可进一步提高该项技术的成功率。Objective to evaluate the reason for the failure of transcatheter closure of ventricular septal defect and to find the measures of prevention. Methods ClinicAl data from 620 patients, who were failured in transeatheter closure of ventricular septal defeet from Jan 2006 to Dec 2007, were retrospectively analyzed. We made a comprehensive analysis of the reason for the failure of interventional treatment according to the outcome of left ventriculography, Aortograms and transthoraeic eeheeardiography. Results The total failure rate of the interventional treatment is 8% （50/620）. The cause of failure does not include Disruption of membranous part tumor, oeeluder displacement and hemolysis after interventional treatment. In 50 cases of unsuccessful interventional treatment, including 5 eases with Aortic Valvular Prolapse, 8 eases arise tricuspid aortae valve regurgitation ,4 eases have been forced to stop operation because Complete Left Bundle Branch Bleck or Complete right Bundle Branch Block often appear. 3 eases have been forced to take oceluder bank because Complete Left Bundle Branch Block, Complete right Bundle Branch Block or Ⅲ - degree atrloventrieular block arisen. 3 eases have been forced to take oeeluder hack by surgery for appearing three - degree atrioventrieular block can not be restored. 3 eases lost because the interventional treatment made tricuspid valve regurgitation more serious. In 4 eases of Muscular ventrieular septal defect patie nts,ineludeing the shunt volume of ventricular septal defect less than 2mm in 2 eases and we can not set up orbit in transeatheter closure of ventricular defect in 2 cases. 1 patient died because of subarachnoid hemorrhage. Conclusion For most people with ventrieular septal dofect, transcatheter closure of ventrieular defect is safe and effectie. We can increase success ratio by according to indications strictly,making use of many inspection method and applying the right strategies and tactics.

关 键 词：室间隔缺损 心脏导管插入术 影像学 超声心动图 

分 类 号：R654.2[医药卫生—外科学] R735.7[医药卫生—临床医学]