小儿膜周部室间隔缺损介入治疗的临床疗效  

Clinical Effect of Transcatheter Closure in Children with Perimembranous Ventricular Septal Defect

作　　者：赵胜[1] 江荣[1] 汪泽龙[1] 

机构地区：[1]安徽省立儿童医院心内科,合肥230051

出　　处：《实用儿科临床杂志》2012年第13期1000-1002,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的观察小儿膜周部VSD介入治疗的疗效、对心律的影响及封堵前后左心血流动力学指标变化。方法收集2006年8月-2009年12月本科44例接受介入治疗的膜周部VSD患儿。男17例,女27例;年龄2.4～13.0(5.20±2.68)岁。其中37例选用对称型封堵器,7例选用偏心型封堵器,经造影和经胸超声心动图证实封堵器位置良好,无成束残余分流,主动脉瓣和三尖瓣功能不受影响,即为封堵成功。术前,术后3 d、1个月、3个月、6个月、12个月检查其ECG及经胸超声心动图检测左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVDS)、射血分数(EF)和左心室缩短分数(FS)。结果 43例封堵成功,成功率为97.7%。其中2例有不成束残余分流,分别于术后3 d和术后1个月时消失。术后新出现不完全右束支传导阻滞4例,1例12个月时转为完全性右束支传导阻滞,1例随访中不完全右束支传导阻滞消失,无高度房室传导阻滞发生。与术前相比,LVDD和LVDS在术后3 d和术后1个月时明显缩小(P<0.01,0.05),术后12个月时虽短于术前,但差异无统计学意义,EF和FS术前术后无显著变化。结论小儿膜周部VSD介入治疗是一种安全有效的方法。Objective To evaluate the efficacy of transcatheter closure for perimembranous ventricular septal defect （VSD）, the effects on cardiac rhythm and the changes of left ventricular hemodynamics in children. Methods From Aug. 2006 to Dec. 2009,44 children with peri-membranous VSD were treated with transeatheter closure. There were 17 boys and 27 girls, averagely aged 2.4 - 13.0 （ 5.20 ：l： 2.68 ） years. Of them ,37 eases were treated with symmetric occluders and 7 cases with eccentric ones. After the occlusion performed, if left ventricle imaging and transthoracic echoeardiography suggested the occluder located appropriately with non - fascieularly residual shunt and the function of aortic valve or tricuspid valve not affected, the treatment was successful. Electrocardiogram and transthoraeie eehocardiography were per- formed, preoperatively and 3 days, 1 month ,3 months ,6 months and 12 months postoperatively, to observe rhythm and measure left ventricular end - diastolic diameter （LVDD） ,left ventricular end - systole diameter （LVDS）, ejection fraction （ EF）, shortening fraction （ FS ）. Results The occluders were implanted successfully in 43 cases,with success rate 97.7%. Two cases of the success remained non - fascicularly re- sidual shunt but disappeared respectively after 3 days and 1 month. After the procedure, no high degree atrio - ventricular block occurred, but incomplete right bundle branch block occurred in 4 cases. Of them, 1 case developed complete right bundle branch block at 12 months of ob- serving time and 1 ease recovered during follow - up. After 3 days and 1 month, LVDD and LVDS decreased significantly （ P 〈 0. 01,0.05 ）. Though after 12 months ,they were shorter than pre - occlusion,the changes were not significant. There were no remarkable changes between pre - occlusion and post - occlusion in EF and FS. Conclusion Transcatheter closurete of perimembranous VSD is a safe and effective thera- py on children.

关 键 词：膜周部室间隔缺损 介入治疗 儿童 

分 类 号：R725.4[医药卫生—儿科]