先天性室间隔缺损介入失败后封堵器取出术14例  

Surgical Occluder Removal after Interventional Failure in 14 Children with Congenital Ventricular Septal Defect

作　　者：李江林[1] 徐哲[2] 李渝芬[1] 张智伟[1] 庄建[3] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院心儿科,广州510100 [2]中山大学附属第一医院小儿外科,广州510080 [3]广东省心血管病研究所广东省人民医院广东省医学科学院心外科,广州510100

出　　处：《实用儿科临床杂志》2010年第11期794-797,共4页Journal of Applied Clinical Pediatrics

基　　金："十一.五"国家科技支撑计划项目(2007BAI05B03)

摘　　要：目的回顾性分析因介入失败或严重并发症需行外科手术取出封堵器的先天性室间隔缺损(VSD)患儿的资料,总结其经验教训。方法收集2003年3月-2009年12月行封堵器取出术的VSD患儿14例,分析其临床资料,VSD大小、形态,使用的封堵器型号,介入治疗并发症,外科手术中所见及手术效果等。对比有残余分流组和无残余分流组VSD和封堵器大小有无差异。结果 14例患儿平均年龄6.5岁(3.0～12.3岁);体质量21.3kg(13.5～40.0kg)。VSD均为膜周型,12例为膜周流入道型伴膜部瘤,左室面大小4～15mm,封堵器大小6～10mm。有残余分流组与无残余分流组VSD和封堵器大小比较差异均无统计学意义(t=1.074,P=0.388;t=0.691,P=0.523)。介入治疗并发症包括残余分流6例(3例并机械性溶血),瓣膜损伤5例(三尖瓣狭窄3例、重度三尖瓣返流和中度主动脉瓣返流各1例),完全性房室传导阻滞(cAVB)2例(年龄均为4岁,1例术中出现完全性右束支传导阻滞),封堵器成形不良不能回收1例。14例患儿均在全麻和体外循环下行封堵器取出及VSD修补术,全部痊愈出院,手术效果满意,无新增严重并发症。结论常见的VSD封堵术严重并发症包括cAVB、瓣膜损伤和残余分流并机械性溶血,最常发生于膜周部VSD伴膜部瘤形成的患儿,应慎重对待这一类型的介入治疗,个体化选择封堵器。VSD封堵过程最常损害的瓣膜是三尖瓣。年龄小、较大的膜周流入道型VSD伴膜部瘤形成、介入术中曾出现传导阻滞的患儿可能更倾向于并cAVB。VSD封堵失败后行外科手术取出封堵器同时修补缺损是安全有效的补救措施。Objective To retrospectively analyze clinical data of congenital ventricular septal defect（VSD） children who underwent surgical occluder removal because of interventional failure or severe complications, and to summarize the experience and lesson. Methods A to- tal of 14 children were involved in this study from Mar. 2003 to Dee. 2009. Clinical data, diameter and pattern of VSD, oceluder type, interven- tional complications and outcome of surgery were analyzed. The diameter of VSD and the size of occluders were compared between the residual shunt group and non - residual shunt group. Results Fourteen children ranged from 3.0 to 12.3 years old （ mean 6.6 years old）. Their weights ranged from 13.5 to 40.0 kg （ mean 21.3 kg）. All the VSD children were perimembraneous type and 12 cases of them had aneurys- mal shape. VSD diameter ranged from 4 to 15 nun. The size of occluders ranged from 6 to 10 mm. Neither the diameter of VSD nor size of oe- eludem had significant difference between the residual shunt group and non - residual shunt group （ t = 1. 074, P = 0. 388 ; t = O. 691, P = 0. 523 ）. Complications of interventional closure included residual shunt in 6 cases （3 cases complicated with mechanical hemolysis）, valvular injury in 5 cases （tricuspid stenosis in 3 cases, severe tricuspid regurgitation in 1 case,moderate aortic regurgitation in 1 ease） ,complete atrio- ventrieular block（ eAVB）in 2 cases （both in 4 years old, 1 case with complete right bundle branch block during interventional procedure）, and failed in retrieval of oecluder since unsatisfactory location in 1 child. All the 14 children underwent surgical occluder removal and defect closure under general anesthesia and extraeorporal bypass with satisfactory outcome. There were no other severe complication. Conclusions Severe complications of interventional closure of perimembraneous VSD included eAVB ,valve injury and residual shunt resulting in mechani- cal hemolysis. They were most likely to happen in perimembraneous VSD

关 键 词：先天性室间隔缺损 介入治疗 并发症 外科手术 

分 类 号：R541.1[医药卫生—心血管疾病]