经导管封堵主动脉窦瘤破口的临床评价  

Clinical analysis on transcatheter closure of ruptured sinus of valsalva aneurysm

作　　者：成革胜[1] 杜亚娟[1] 何璐[1] 王星烨[1] 张玉顺[1] 

机构地区：[1]西安交通大学医学院附属第一医院心内二科,西安710061

出　　处：《岭南心血管病杂志》2014年第2期188-190,217,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的 探讨经导管封堵主动脉窦瘤破裂的临床效果.方法 8例患者,年龄17～44岁.其中5例为主动脉右冠状动脉窦瘤破裂入右心室,破口直径2.5～13 mm;2例为主动脉右冠状动脉窦瘤破裂入右心房,破口直径4～8 mm;1例为主动脉无冠状动脉窦瘤破裂入右心室,破口直径6 mm.7例为先天性,1例为获得性（医源性）.通过建立股动脉-主动脉窦瘤破口-右心室（或右心房）-右心房-股静脉的轨道,透视下经股静脉置入合适的动脉导管未闭封堵器,所选择的封堵器直径较破口大（2～5 mm）.结果 5例患者封堵成功,无并发症发生.随访2～4年,5例患者症状和体征均消失,超声证实封堵器形态位置良好,无残余分流、栓塞、细菌性心内膜炎、主动脉瓣反流等发生.1例封堵后1周封堵器脱落,脱入右下肺动脉,转外科手术取出封堵器同时行主动脉窦瘤修补.1例因破口大置入封堵器后影响右冠状动脉开口,放弃介入治疗转外科手术治疗.1例置入封堵器后因主动脉瓣反流,放弃封堵治疗继续观察.结论 术前选择合适的患者,经导管主动脉窦瘤破口封堵术为一种微创、安全和有效的治疗方法.其中、远期疗效良好,临床应用前景较好.Objectives To investigate the clinical effect of transcatheter closure of ruptured sinus of valsalva aneurysm. Methods Eight patients aged 17-44 were included. Among them, 5 cases had aortic right coronary sinus aneurysm ruptured into the right ventricle, the echo estimated size of the defect was 2.5-13 mm; 2 cases had aortic right coronary sinus aneurysm ruptured into the right atrium, the defect diameter was 4-8 mm; 1 case had aortic non-coronary sinus aneurysm ruptured into the right ventricle, the diameter was 6 mm. Seven cases were congenital and 1 case was post- interventional. After establishment of arteriovenous wire loop, ductus arteriosus occluder was successfully deployed by femoral venous approach in all patients. The diameter of the occluder was chosen to be at least 2-5 mm larger than the defect. Results Five patients received successful closure and no complications occurred. Following up for 2 to 4 years, symptoms and signs of the 5 patients disappeared and ultrasound confirmed the occluder shape was in good position. No residual shunt, embolization, bacterial endocarditis or aortic regurgitation occurred. For one case, the occluder fell into the lower right pulmonary artery in 1 week. The device was removed through surgical operation and sinus of valsalva aneurysm was repaired at the same time. One case with a big defect received surgical operation after interventional therapy was given up because of the coronary artery. One case after occluder implantation gave up interventional treatment for aortic regurgitation and received continuous observation. Conclusions Transcatheter occlusion is a minimally invasive, safe and effective treatment for closure of ruptured sinus of valsalva aneurysm. The middle and long term effects of transcatheter occlusion are good and it is worth applying to the clinic.

关 键 词：动脉瘤 VALSALVA窦 封堵 

分 类 号：R543.16[医药卫生—心血管疾病]