应用偏心型封堵器经皮介入治疗干下型室间隔缺损的可行性分析  

Clinical Feasibility of Percutaneous Closure for Subarterial Ventricular Septal Defect Using Asymmetric Occluder Device

作　　者：邱旭[1] 冯沅[2] 干昌平[1] 安琪[1] 石应康[1] 

机构地区：[1]四川大学华西医院心血管外科,成都610041 [2]四川大学华西医院心脏内科,成都610041

出　　处：《华西医学》2013年第6期848-851,共4页West China Medical Journal

基　　金：国家自然科学基金(81170234)~~

摘　　要：目的观察和评价采用偏心型封堵器导管介入治疗干下型室间隔缺损的近期疗效和安全性。方法 2011年8月-12月,6例经无主动脉瓣脱垂的干下型室间隔缺损(直径≤7 mm)患者(年龄>3岁)在杂交手术室接受介入治疗。造影评估后,建立动静脉轨道,在保留导丝的情况下置入合适型号的国产偏心型室间隔缺损封堵器,并于术后定期随访复查。结果 6例患者缺损直径4～7 mm(平均5.3 mm),其中5例成功地接受了导管介入封堵治疗,置入封堵器直径5～9 mm(平均6.4 mm)。仅1例因封堵器置入后出现主动脉瓣受压影响关闭,即改由外科微创经胸封堵成功。所有患者在随访期内,无栓塞、残余分流、瓣膜功能障碍、房室传导阻滞、死亡等并发症。结论无主动脉瓣脱垂的干下型室间隔缺损患者接受导管介入封堵治疗是安全、可行的,且短期随访结果良好。Objective To investigate the effect and security of transcatheter closure of doubly committed subarterial（DCSA） ventricular septal defect（VSD） with eccentric occluder device.Methods From August to December 2011,6 patients（older than 3 years） with DCSA VSD（diameter of defect less than or equal to 7 mm） underwent interventional therapy in hybrid operating room.After left ventricular angiography and arteriovenous circuit establishment,with hydrophilic coating guide wire retained,the proper size of domestic made eccentric VSD occluder was advanced through the delivery sheath to release.Clinical follow-up program was performed after the procedure.Results The diameter of VSD ranged from 4 to 7 mm（mean 5.3 mm）.The devices were implanted successfully in 5 of 6 patients.The waist size of devices in achieved cases ranged from 5 to 9 mm（mean 6.4 mm）.One patient was treated by intraoperative device closure immediately because of aortic insufficiency caused by impingement on the right coronary cusp after occluder deployment.There was no device embolism,residual shunt,valvular dysfunction,atrioventricular block or mortality during follow-up period.Conclusion Transcatheter device closure of DCSA VSD without aortic valve prolapse appears to be safe and feasible with good outcomes of short-term follow-up.

关 键 词：干下型室间隔缺损 主动脉瓣脱垂 导管介入 封堵器 微创治疗 

分 类 号：R541.1[医药卫生—心血管疾病]