应用肌部室间隔缺损封闭器封堵低体质量婴幼儿动脉导管未闭  

Application of muscular ventricular septal defect occluders in the therapy of uderweight infants and young children with patent dutus arterriosus

作　　者：戴辰程[1] 郭保静[1] 金梅[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏科,北京100029

出　　处：《心肺血管病杂志》2011年第5期392-395,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家"十一五"支撑计划(项目编号:2007BA105B03)

摘　　要：目的:探讨肌部室间隔缺损(VSD)封闭器在低体质量婴幼儿动脉导管未闭(PDA)介入治疗中临床应用的安全性及优点。方法:2010年10月至2011年6月,应用肌部VSD封闭器对9例低体质量婴幼儿PDA进行介入治疗,男性1例,女性8例,年龄6～21个月,体质量5.5～10 kg。本组病例均行经胸超声心动图、心导管检查及造影检查。结果:合并肺动脉高压者8例,轻、中及重度分别为2例、5例及1例。肺/体循环血量比(QP/QS)为1.94～2.87,肺血管阻力指数(TPRI)1.82～4.7wood/m2。造影示4例为粗大PDA,1例为漏斗腔大的PDA,4例漏斗腔短小,其中1例为主动脉右弓右降合并迷走左锁骨下动脉及左位PDA,PDA距左锁骨下动脉及椎动脉近。9例患儿全部封堵成功,合并肺动脉高压者释放封闭器前肺动脉压力降至正常或接近正常,未发生医源性主动脉和肺动脉狭窄及血管内膜损伤。术后随访无封闭器脱落、残余分流,左心室舒张末径(LVED)较术前明显减小,4例合并二尖瓣反流者3例减轻。结论:对于低体质量婴幼儿粗大、漏斗腔短小或应用常规PDA蘑菇形封闭器治疗效果不佳的PDA,应用肌部VSD封闭器更安全有效。Objective：To evaluate the safety and advantage of application of muscular ventricular septal defect in the therapy of uderweight infants and young children with patent dutus arterriosus.Methods：Nine uderweight infants and young children（1 male and 8 fomale）with patent dutus arterriosus,aged from 6 to 21 months and weighted from 5.5 to 10kg,underwent transcathter intervention with muscular VSD occluders from October 2010 to June 2011.All patients accept transthoracic echocardiography,cardiac catheterization and angiocardiography.Results：8 patients were associated with pulmonary hypertension.There are 2,5,and 1 patients were diganosed as mild,middle and severe pulmonary hypertension respectively.QP/QS ranged from 1.94 to 2.87 and total pulmonary resistance index ranged from 1.82 to 4.7 Wood.m2.Angiocardiography indicated there were 4 large PDAs,1 PDA with large infundibulum,and 4 PDAs with short and small infundibulum,one of which was right aortic arch and left PDA.Nine PDAs were successfully closed with muscular ventricular septal defect occluders.Pulmonary tension decreased to normal or nearly normal.No residual shunt,occluders falling off,vascular injury,or iatrogenic stenosis of pulmonary artery and descending aorta were found.3 of 4 patients with mitral regurgitation relieved.Conclusion：Muscular VSD occluder is available and effective to close large PDA,PDA with short and small infundibulum or PDA which can not be successfully closed with Amplatzer PDA occluders in uderweight infants and young children.

关 键 词：动脉导管未闭 肌部室间隔缺损 封闭器 介入治疗 先天性心脏病 

分 类 号：R541.1[医药卫生—心血管疾病]