小腰大边封堵器和对称封堵器经导管介入治疗巨大囊袋形室间隔缺损的对比研究  

Comparative study of transcatheter intervention of VSD with large sack with thin-waist-big-side occluder and symmetrical occluder

作　　者：李寰[1] 李军[2] 张军[2] 张玉顺[1] 胡涛[1] 范延红[1] 李家一[1] 代政学[1] 王海昌[1] 

机构地区：[1]第四军医大学西京医院心血管内科,西安市710032 [2]第四军医大学西京医院超声诊断科,西安市710032

出　　处：《中国介入心脏病学杂志》2009年第6期305-307,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨巨大囊袋形室间隔缺损采用小腰大边封堵器和对称封堵器经导管介入治疗的适应证。方法2004年8月至2008年12月在我科行室间隔缺损封堵术的患者,超声和左心室造影检查为巨大囊袋形室间隔缺损者共计132例,其中男59例,女73例;年龄18.2±10.6(2～49)岁;缺损口左室面直径13.8±4.5(10～24)mm。按选用封堵器的类型分为小腰大边封堵器组和对称封堵器组。术后随访心脏彩色多普勒超声和ECG变化。结果小腰大边封堵器组58例,其中男23例,女35例,年龄12.8±10.9(2～32)岁,植入封堵器腰部直径6～16mm;对称封堵器组74例,其中男36例,女38例,年龄15.4±10.8(2～49)岁,植入封堵器腰部直径6～24mm。小腰大边封堵器组和对称封堵器组术后3～6个月残余分流的发生率(3.4%比4.1%),新出现的三尖瓣反流(5.2%比5.4%)、主动脉瓣反流(3.4%比6.8%)和右室流出道狭窄(3.4%比5.4%)差异均无统计学意义(P>0.05)。两组术后ECG变化差异无统计学意义(P>0.05)。结论小腰大边封堵器和对称封堵器经导管介入治疗巨大囊袋形室间隔缺损效果满意,但需要注意两种封堵器选择的不同适应证,以保证最好的封堵治疗效果。Objective To investigate the clinical outcomes of transcatheter intervention of VSD with large sack thin-waist-big-side with VSD occluder or with symmetrical oeeluder. Methods One hundred and thirty two patients （59 males, 73 females） aged from 2 to 49, were diagnosed with VSD with large sack by echocardiogram and left ventriculography and all the patients underwent transcatheter occlusion from Aug. 2004 to Dee. 2008. The mean size of the VSD in left ventricular side was 13.8±4. 5 （range from 10 to 24） ram. The patients were divided into the thin-waist-big-side oecluder group and the symmetricl oecluder group according to occluder type used. Echocardiogram and ECG were examined during the follow-up. Results Fifty eight patients （23 males, aged 12. 8 ± 10. 9 （range from 2 to 32） were treated with thin-waist-big-side oecluder and the diameter of the occludes ranged from 6 to 16 mm. Seventy tbur patients （36 males, aged 15.4 ± 10. 8 years old, range from 2 to 49 years old） were treated with symmetrical occluders and the diameter of the occluder ranged from 6 to 24 nun. After the follow-up of 3 - 6 months, the incidences of residual shunt （3.4% vs 4. 1% ） , new on-set of tricuspid valve regurgitation （ 5.2% vs 5.4% ） and aortic valve regurgitation （3.4 vs 6. 8% ） and the incidence of right ventricular outflow tract stenosis （3.4 vs 5.4% ） had no significant differences between the 2 group （ P 〉 0. 05 ） . There was also no significant differences in ECG changes between the 2 group （ P 〉 0. 05）. Conclusions Transcatheter intervention of VSD with large sack both thin-waist-big-side oeeluder or symmetrical occluder showed satisfactoly result. Attention should be paid in the indications of these 2 types of occluders.

关 键 词：室间隔缺损 心脏导管插入术 封堵器 

分 类 号：R654.2[医药卫生—外科学] R541.1[医药卫生—临床医学]