国产封堵器封堵嵴内型室间隔缺损:46例回顾封堵过程中选择类型、确定大小、避免损伤的经验  

Interventional occlusion of intracristal ventricular septal defects using domestic occluder: Experience of type selection, size definition and injury avoidance in 46 cases

作　　者：程应樟[1] 李正章[1] 吴险峰[1] 吴清华[1] 程晓曙[1] 李运德[1] 吴延庆[1] 

机构地区：[1]南昌大学第二附属医院心内科,江西省南昌市330006

出　　处：《中国组织工程研究与临床康复》2010年第4期740-743,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:嵴内型室间隔缺损封堵治疗一直是室间隔缺损封堵的难点,成功率不高,对其造影特点和使用国产封堵器封堵成功病例报道少见。观察嵴内型室间隔缺损造影特点及使用国产封堵器的封堵治疗效果。方法:经彩色多普勒超声心动图证实有介入适应证的嵴内型室间隔缺损患者46例,按主动脉短轴切面缺损口部位分成4组:A组为11点半～12点,B组为12点～12点半,C组为12点半～1点,D组为1点～1点半。对不同组别采用不同体位造影显示室间隔缺损,依此制定封堵策略,选择封堵器和封堵方式。结果:46例患者均封堵成功,成功率100%,无相关并发症发生。46例嵴内型室间隔缺损患者中A组10例,B组13例,C组16例,D组7例。嵴内型室间隔缺损左心室造影左前斜投照角度大,而且随着缺损部位变化(A组至D组)逐渐加大。根据缺损口大小及分组分别使用对称型、偏心型、零偏心型封堵器,均封堵成功。改良猪尾导管在嵴内型室间隔缺损封堵过程中效果显著。结论:嵴内型室间隔缺损左心室造影特点是左前斜投照角度大,国产封堵器介入封堵嵴内型室间隔缺损患者安全、有效、并发症少、费用低,可作为有封堵适应证室间隔缺损患者的首选方案。OBJECTIVE： Interventional occlusion of intracristal ventricular septal defects （IVSD） is a node point. Reports concerning angiography features and successful occlusion of IVSD using domestic occluder are rare. The aim of this paper is to investigate the angiography features of IVSD and the experience of interventional occlusion with domestic occluder. METHODS： Totally 46 cases of IVSD were diagnosed by color Doppler echocardiography that they had interventional indications. According to the short axis view of aortic, they were divided into 4 groups： A （11：30-12：00）, B （12：00-12：30）, C （12：30-13：00） and D （13：00-13：30）. Different groups were performed with adequate angle angiography to show ventricular septal defect, as well as to decide strategy, which to choose occluder and occluded methods. RESULTS： All 46 patients were occluded successful. Technical success rate was 100%, without related complications. A group included 10 cases, B group 13 cases, C group 16 cases and D group 7 cases. The left anterior oblique angle of IVSD left ventricular angiography was greater than other type of VSD, and increased gradually with the changes in the defect location （Group A to D）. According to the defect size and different groups, the defects were successfully occluded with symmetric, decentered, zero-decentered type occluder. Modified pigtail catheter was good value in practice occlusion of IVSD. CONCLUSIONS： Left anterior oblique angle in IVSD left ventricular angiography should be bigger. Domestic occluder is safe, effective, with less complication and cost, which can be the first choose for patients with LVSD.

关 键 词：室间隔缺损 嵴内型 左心室造影 介入治疗 国产封堵器 心血管植入物 

分 类 号：R318[医药卫生—生物医学工程]