影像学分析在室间隔缺损介入封堵术中的临床价值  

The clinical value of imaging analysis in transcatheter closure of ventricular septal defect by using the occluder

作　　者：许美珍[1] 罗来树[1] 李颐[1] 程应樟[1] 李运德[1] 吴延庆[1] 吴清华[1] 程晓曙[1] 

机构地区：[1]330006南昌大学第二附属医院心内科

出　　处：《介入放射学杂志》2011年第12期935-938,共4页Journal of Interventional Radiology

摘　　要：目的通过对左心室及主动脉造影影像学分析,探讨其对室间隔缺损(VSD)介入封堵术的临床价值。方法收集2009年1月至2011年2月行封堵治疗的VSD患者共106例。分别于封堵前、后常规以LAO 45°～55°+CRA 25°行X线左心室造影和主动脉瓣上造影。对于嵴内型、嵴下型的影像学区别,采用加大角度投照(LAO 75°+CRA 35°),而肺动脉干下型采用RAO35°左心室造影,在造影显示VSD分流后分别测量左室侧分流口大小及其距主动脉瓣的距离,并进行介入封堵。分析所有患者手术前、后左心室和主动脉造影的影像学资料。结果成功封堵97例,均无并发症发生。其中7例嵴内型较小缺损,12例嵴下型,均使用零偏型伞封堵成功,1例为肌部VSD,其余77例为膜周部VSD。2例心脏多普勒超声诊断为嵴下型,X线左室造影为膜周部。8例心脏多普勒超声诊断为膜周部,X线左室造影为嵴下型。失败的9例均为嵴内型VSD,其中心脏多普勒超声诊断2例为嵴下型,1例为膜周部,X线左心室造影均表现为嵴内型。心脏多普勒超声与X线左室造影比较,在诊断嵴下型和嵴内性方面差异有统计学意义(P<0.05);而在膜周部型和肌部VSD方面差异无统计学意义(P>0.05)。结论 X线左心室及主动脉造影的影像学判定对VSD封堵术具有重要作用。Objective To discuss the clinical value of left ventriculography and aortography in performing transcatheter closure of ventricular septal defect（VSD） by using the occluder.Methods During the period from January 2009 to February 2011,a total of 106 patients with VSD were encountered in the hospital.Transcatheter closure by using the occluder was carried out in all patients.Left ventriculography and aortography（LAO 45°-55° ＋ CRA 25°） were performed before and after the closure procedure.Larger angle projection（LAO 75°＋ CRA 35°） was also employed in order to distinguish the intracristal VSD from infracristal VSD,while RAO 35° was adopted for angiography of subpulmonic VSD.The size of left ventricular defect shunt and the distance from the defect to the aortic valve were measured.The transcatheter closure procedure was performed.The preoperative and postoperative imaging findings of left ventriculography and aortography were analyzed.Results VSD was successfully occluded in a total of 97 cases and no complications occurred.Among these cases,small intracristal VSD was seen in 7 and infracristal VSD in 12,and all of them were successfully occluded by using the nitinol asymmetric occluder.One case was affected with muscular VSD and the remaining 77 cases suffered from perimembranous VSD.In two cases,echocardiographic diagnosis was infracristal VSD but left ventriculographic diagnosis was perimembranous VSD.In other 8 cases,the diagnosis made by echocardiography was perimembranous VSD,while the diagnosis made by left ventriculography was infracristal VSD.The procedure was unsuccessful in 9 patients,and all of them were intracristal VSD which were confirmed by left ventriculography,but echocardiography diagnosed infracristal VSD in only 2 and perimembranous VSD in one of these 9 cases.Statistically significant difference in diagnosing infracristal and intracristal VSD existed between left ventriculography and echocardiography（P 0.05）,while no significant difference in diagnosing perimembranous a

关 键 词：室间隔缺损 介入封堵术 影像学分析 临床应用 

分 类 号：R541.1[医药卫生—心血管疾病]