经导管介入治疗90例室间隔缺损疗效观察  

Evaluation of trans-catheter closure in 90 cases of congenital ventricular septal defect

作　　者：赵立健[1] 韩波[1] 张建军[1] 庄建新[1] 靳有鹏[1] 王玉林[1] 

机构地区：[1]山东大学附属省立医院儿科,济南250021

出　　处：《山东大学学报（医学版）》2010年第5期89-92,共4页Journal of Shandong University:Health Sciences

摘　　要：目的评价经导管介入治疗先天性室间隔缺损(VSD)的疗效及并发症。方法 2005～2007年我科共收治VSD患者90例,经导管介入治疗成功86例,对所有病例的临床资料、手术前后心电图、心脏超声、术中心脏造影、选择封堵器械及随访资料进行回顾性分析。结果 90例VSD患者中,男40例,女50例,年龄分布2～34岁(平均8.9岁)。87例为膜部室间隔缺损,3例为嵴内型,1例为VSD外科修补术后残余瘘,1例合并动脉导管未闭(PDA)。封堵成功86例,技术成功率为95.6%。VSD右室面最大直径为1.5～8.8mm,植入封堵器直径为4～18mm。17例采用AGAAmplatzer封堵器,13例采用国产小腰大边封堵器,52例采用国产同心圆型封堵器,2例采用国产偏心型封堵器。平均随访时间18个月。并发症30例,包括:完全性右束支传导阻滞(CRBBB)3例,不完全性右束支传导阻滞(ICRBBB)2例,左前分支传导阻滞(LABB)7例,CRBBB并LABB1例,1例术中出现间歇性Ⅲ度房室传导阻滞(AVB),2例术后出现交替性CRBBB及完全性左束支传导阻滞(CLBBB),加速性交界性自主心律6例,均为一过性,随访1周～3个月消失。残余分流3例,其中1例合并机械性溶血,对症处理后好转出院。主动脉瓣少量返流2例,三尖瓣返流3例,均为少量～中量返流,未行特殊处理。结论经导管封堵VSD是一种安全有效的治疗方法。手术成功率高,严重并发症少,传导阻滞是VSD介入治疗术后的主要并发症,及时发现、及时处理是治疗关键,对心内传导系统远期的影响仍需进一步评价。Objective To evaluate the therapeutic effect of trans-catheter closure of ventricular septal defect（VSD）.Methods During 2005 to 2007,a total of 90 cases diagnosed as congenital VSD were admitted to our department,of which 86 cases successfully underwent trans-catheter closure.The clinical data including electrocardiogram and transthoratic echocardiography before and after intervention,angiogram during intervention,implanted occluder devices and follow-up data of all patients were analyzed.Results Among the 90 patients,40 were male and 50 were female,aged from 2 to 34 years（mean age,8.9 years）.87 had perimembranous ventricular septal defect,3 intercristal ventricular septal defect,1 residual fistula after surgery repair and 1 patent ductus arteriosus.86 cases（95.6%）were successfully occluded.The VSD diameter was 1.5-8.8 mm.The implanted occluder device diameter was 4-18 mm.An amplatzer membranous VSD occluder was used in 17 cases,a home-made thin-waist-big-side occluder in 13 cases,a home-made concentric occluder in 52 cases and a home-made eccentric occluder in 2 cases.The average follow-up time was 18 months.30 cases presented various complications including 3 cases of CRBBB,2 case of ICRBBB,6 cases of accelerated junctional tachycardia,which were all transient,disappearing after 1 week-3months.Residual shunt occurred in 3 cases,and 1 case had mechanical hemolysis,which resolved 7 days later after conservative therapy.Aortic valve regur-gitation occurred in 2 cases and tricuspid regurgitation occurred in 3 cases.All the regurgitations were mild to moderate and no further treatment was performed.Conclusions Trans-catheter closure of peri-membraneous VSD is safe and efficacious,and the success rate is high with rare severe complications.Conduction blockades are the main complications.It is important to be diagnosed and treated in time.Further follow-up studies are required to document the long-term effect on the intracardiac conduction.

关 键 词：室间隔缺损 经导管关闭 并发症 随访 

分 类 号：R725.4[医药卫生—儿科]