动脉导管未闭封堵器在儿童膜部瘤室间隔缺损介入治疗中的应用研究  

Application study on catheterization to pseudoaneurysm of membranous ventricular septal defect with patent ductus arteriosus occlusion devices in children

作　　者：项云[1] 都鹏飞[1] 杨善志[1] 范晓晨[1] 程自平[1] 

机构地区：[1]安徽医科大学第一附属医院儿科,合肥230022

出　　处：《中国医师进修杂志》2011年第6期1-3,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的应用动脉导管未闭（PDA）封堵器介入治疗儿童膜部瘤室间隔缺损（VSD），总结其技术要点及治疗体会。方法20例儿童膜部瘤VSD患儿，根据左室造影结果分别植人不同型号的PDA封堵器，封堵器腰部直径（10．4±2．6）mm；术中经胸心脏超声检查、封堵后15min重复左室造影，观察即刻封堵效果。结果20例采用PDA封堵器治疗的膜部瘤VSD患儿中，1例Ⅳ型VSD患儿，因术后残余分流／〉2mm而放弃介入治疗；1例Ⅲ型多孔型VSD患儿术后少量残余分流（〈2mm），1个月后复查心脏超声无残余分流。术后心电图正常（或与术前一致）13例，不完全性右束支传导阻滞4例，第一度房室传导阻滞1例，阵发性交界性心动过速1例。心电图恢复正常时间≤6d。结论经导管采用PDA封堵器治疗儿童膜部瘤VSD疗效可靠，治疗关键是选择合适的封堵器，根据膜部瘤的形态、大小、位置确定封堵部位，是介入治疗该种类型VSD的可选方法之一。Objective To study on transcatheter closure of membranous ventricular septal defect （VSD） with pseudoaneurysm by patent ductus arteriosus（ PDA ） occlusion devices in children and summarize the skill and clinical experience. Methods ＂ The study included 20 membranous VSD cases in children. According to the finding of the left ventricular angiography, various kinds of the PDA occlusion devices was implanted. The mean diameter of the waist of the occluder was （ 10.4 ± 2.6 ） mm. Examination by transthoracic echocardiography （TIE） immediately and left ventricular angiography after the occluder was implanted 15 minutes later to evaluate the efficacy. Results In the 20 patients, one of the Ⅳ type VSD patient was quitted because of the significant residual shunts（ ≥2 mm）. Slightly residual shunts（ 〈 2 mm） was found in one Ⅲ type VSD patient with multi-outlet. And disappeared in 1 month after the procedure, which VSD patient was confirmed by TTE. Thirteen cases were normal by EKG examination （or the same before procedure）. Incomplete right bundle branch block was found in 4 cases. First degree atrioventricular block was found in 1 case and paroxysmal junctional tachycardia was found in 1 case. All of them were recovered in 1 week. Conclusions Transcatheter interventional therapy with PDA occlusion devices for membranous VSD with pseudoaneurysm is safe and effective. The key of the procedure is to select suitable occluder and suitable position to plant them according to the membranous morphologic characteristics, size and position of the pseudoaneurysm. It is a facultative method for transcatheter therapy this kind of congenital heart disease.

关 键 词：室间隔缺损 肿瘤 动脉导管未闭 封堵器 经导管关闭 

分 类 号：R541.1[医药卫生—心血管疾病]