微创封堵治疗先天性心脏病复合缺损11例报告  

COMBINED TREATMENT FOR COMPLEX CONGENITAL HEART DEFECT WITH MINIMALLY INVASIVE DEVICE CLOSURE:EXPERIENCE IN 11 PATIENTS

作　　者：邢西忠[1] 张凤伟[1] 瞿晓琨[1] 景昊[1] 王恩伟[1] 贾旭升[1] 

机构地区：[1]临沂市人民医院心外科,山东临沂276003

出　　处：《山东医学高等专科学校学报》2011年第2期111-114,共4页Journal of Shandong Medical College

摘　　要：目的探讨先天性心脏病复合缺损微创封堵治疗的手术方案,总结治疗方法和经验。方法对11例先天性心脏病复合缺损患者进行了微创封堵治疗,采用胸骨下端纵切口、胸骨左缘第2肋间横切口+胸骨右缘第4肋间横切口,胸骨左缘第3、4肋间横切口(微创切口),长度在3 cm内。术中安放食道超声探头。复合缺损合并VSD者,取胸骨下端纵切口入胸,显露右心室面,在TEE的监测和引导下,经右心室面套管针穿刺,建立通道,采用上海形状记忆合金材料有限公司生产的配套封堵器输送装置封堵VSD;合并PDA者经该穿刺部位建立PDA封堵通道,植入输送装置后封堵PDA;合并ASD者,同一切口内左侧心包放松,拉紧右侧心包牵引线,显露右心房,经右心房封堵ASD。释放封堵伞后,在TEE监测下,查见封堵伞位置恰当,固定可靠,无分流,瓣膜活动不受影响,无流出道梗阻,无心律失常等便可完成封堵。结果 11例患者皆封堵成功。住院3～5 d出院。术后15 d、1月、1年、2年、3年复查,除1例出现迟发性心包积液外(术后20 d),给予心包引流后痊愈出院,其他未发生任何并发症。结论应用该输送装置设计合适手术方案,对先天性心脏病复合缺损实施微创封堵治疗是一种安全、有效、简单的治疗方法。随访结果表明手术可靠,效果好,无并发症,具有很大的临床应用和推广价值。Objective To summarize the experience of minimally invasive device closure for the patient with complex congenital heart defect. Methods Eleven patients with complex congenital heart defects underwent minimally invasive device closure under the guiding of transesophageal echocardiography. The heart surface was ap- proached by small lower longitudinal sternal incision, the left second intercostal space incision ＋ right fourth intercostal space incision and the left third and fourth intercostal space incision （minimally invasive incision,3 cm in length）. Device closure of VSD, ASD and PDA were performed through the puncture of right ventrieular out flow tract, right atrium and main pulmonary trunk respectively. After the release of device, TEE was used to checkcarefully if the device is at the right pcsition and if there is any residual shunt or valve regurgitation. Results The device was implanted in all patients without cardiopulmonary bypass. There was no mortality or major adverse events perioperatively or during the 15 days,, 1 month, 1 year, 2years and 3-years follow-up surveys. One patient had pericardial effusion 20 days after operation and recovered after pericardial drainage. Conclusion Minimally invasive device closure of complex congenital heart defect is simple, safe and effective with excellent outcomes.

关 键 词：先天性心脏病 复合缺损 微创封堵 

分 类 号：R542.5[医药卫生—心血管疾病]