距离主动脉瓣右冠状动脉瓣不足2mm的膜周型室间隔缺损介入封堵效果分析  

The effectiveness analysis of transcatheter closure to perimenberanous ventricular septal defect which was 2 mm away from the right coronary aortic valve

作　　者：尚小珂[1] 张刚成[1] 沈群山[1] 王利军[1] 姚艺[1] 李丁扬 肖书娜[1] 

机构地区：[1]武汉亚洲心脏病医院,湖北武汉430022

出　　处：《中国介入心脏病学杂志》2014年第2期92-97,共6页Chinese Journal of Interventional Cardiology

基　　金：湖北省卫生厅科研项目(JX6B90);武汉市卫生局科研项目(WX13C47)

摘　　要：目的 分析距离主动脉瓣右冠状动脉瓣不足2mm的膜周型室间隔缺损（PmVSD）介入封堵的效果.方法 随机抽取武汉亚洲心脏病医院2005年5月至2012年5月PmVSD介入封堵治疗的患者389例进行回顾性分析,男211例,女178例,年龄3～34 （9.94＆#177;8.53）岁,体重（28.47＆#177;18.11） kg.按照缺损距离主动脉瓣右冠状动脉是否＞2mm分为两组：A组（150例）为术中造影VSD上缘距离主动脉瓣右冠状动脉瓣＜2mm的患者；B组（239例）为术中造影VSD上缘距离主动脉瓣右冠状动脉瓣≥2mm的患者.比较两组患者即刻手术成功率、主动脉瓣反流发生率、术后心律失常、残余分流、机械性溶血、术后三尖瓣反流以及其他并发症的发生率.结果 B组的即刻手术成功率为93.72％,显著优于A组（78.67％）,差异有统计学意义（P＜0.001）.A组患者术后主动脉瓣反流发生率为22例（14.67％）,显著高于B组术后的5例（2.09％）,差异有统计学意义（P＜ 0.001）.次要观察指标中,心律失常发生率、残余分流发生率、机械性溶血发生率、新出现的三尖瓣反流发生率及其他并发症发生率两组间差异均无统计学意义,分别为P=0.314、P=0.392、P=0.573、P=0.385、P=0.946.在VSD直径较小时,使用任意类型封堵器均可获得成功.A组中当VSD直径为5～10 mm时,手术成功率明显降低;VSD直径大于10 mm组的成功率进一步降低,仅1例获得成功（P＜0.05）.B组中或大型缺损成功率比较,差异无统计学意义,但都低于VSD直径≤5mm组的成功率,差异有统计学意义（P＜0.05）.结论 距离主动脉瓣右冠状动脉瓣不足2mm的PmVSD介入封堵总体成功率较低,但缺损直径小于5mm的室间隔缺损仍具有较高的成功率,当缺损直径大于5rnm时成功率非常不理想,有待于更新和改进技术.Objective To analyze the effect of transcatheter closure to perimenberanous ventricular septal defect which was 2 mm away from the right coronary aortic valve. Methods To randomly select 389 paitients to retrospectively analyze in wuhan Asia Heart Hospital form May 2005 to May 2012 which had accepted transcatheter closure of perimenberanous ventricular septal defect, including 211 males and 178 females, 3 - 34 （9.94 ± 8.53） year-old, （28.47± 18.11） kg. According to the distance whether is over 2 mm from the defect to right coronary aortic valve, divided these paitients into two groups：Group A（n=150）： the distance is less than 2 mm; Group B（n=239）：the distance is more than 2 mm.Compared these two groups＇ surgeical success rate, the incidence of aortic regurgitation, arrhythmias, residual shunt, mechanical hemolysis ,tricuspid regurgitation or other complications after surgery. Results The success rate of surgery was much higher in Group A which was 93.72% than Group B which was 78.67%, and this difference had statistical significance（P 〈 0.001）. And The incidence of aortic valve regurgitation after surgery were much higher in Group A which there were 22 cases compared with 5 cases in Group B,and this difference also had statistical significance （P 〈 0.001）. After observing the incidence of secondary indicators,such as arrhythmia, residual shunt, mechanical hemolysis, recent tricuspid regurgitation or other complications after sugery. We found that there were no obvious statistical significance in the difference between these two group （their difference P were 0.314, 0.385, 0.573, 0.392 and 0.946）. Further more, we found that any size of occluders were available the small ventricular septal defect. The surgeical success rate of 5-10mm defect was much higher than the defect diameter which was more than 10 mm, because in the latter group ,there was only one successful case （P 〈 0.05）. It had no statistical significance in the difference of surgeical success rate in Grou

关 键 词：室间隔缺损 主动脉瓣反流 介入封堵 偏心型封堵器 

分 类 号：R541.1[医药卫生—心血管疾病]