891例单纯膜周部室间隔缺损微创经胸封堵术  

Eight Hundred and ninety-one cases with perimembranous ventricular septal defect performed minimally invasive transthoracic device closure

作　　者：刘宏宇[1] 孟维鑫[1] 吴丹[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心脏大血管外科,哈尔滨150001

出　　处：《中国医师杂志》2015年第2期169-172,共4页Journal of Chinese Physician

摘　　要：目的 回顾性分析经胸微创室间隔缺损（VSD）封堵术对单纯膜周部室间隔缺损（PVSD）的治疗效果及安全性.方法 选取本院2008年12月至2014年10月期间891例膜周部室间隔缺损患者,经胸骨中下1/3段3～5 cm正中小切口行微创室间隔缺损封堵术.术中在食道超声心动图（TEE）引导下经右心室表面穿刺,通过VSD释放封堵伞治疗.术中TEE即刻评估封堵伞的位置、对瓣膜有无影响、是否牢固、有无残余分流.术后密切随访观察,定期复查超声心动图、心电图.结果 834例封堵成功,57例中转体外循环下VSD修补手术.其中应用等边封堵伞703只,偏心封堵伞133只,术后随访期间均未出现严重的并发症.结论 经胸微创室间隔缺损封堵术治疗单纯膜周部室间隔缺损近期及中期治疗效果肯定,具有良好的应用前景.目前尚缺乏长期的随访资料,有待进一步的随访观察.Objective To investigate retrospectively the therapeutic effect and safety of minimally invasive transthoracic device closure of isolated perimembranous ventricular septal defect （PVSD）.Methods Eight hundred and ninety-one consecutive patients with PVSD from December 2008 to October 2014 in our hospital were enrolled,which performed minimally invasive transthoracic device closure of ventricular septal defect （VSD）,with a 4 ～ 5 cm incision made on the inferior sternum.Under the guide of transthoracic echocardiography （TEE）,right ventricular free wall was punctured followed by a delivery sheath threaded into the VSD and the occluder was released thereafter.Whether were there residual shunt and the occluder anchored firmly or not,the position of occluder and the influence on heart valve were re-evaluated intraoperatively by TEE.All patients were followed up prudently post-operation.Echocardiography and electrocardiogram were scheduled according to the protocol.Results Eight hundred and thirty-four cases were successfully occluded.Fifty-seven cases were performed VSD repair operation with cardiopulmonary bypass.The amounts of concentric occluder and eccentric occluder were 703 and 133,respectively.The patients performed minimally invasive transthoracic device closure of VSD had no severe complications after operation.Conclusions Although the short-term and mid-term therapeutic effect of minimally invasive transthoracic device closure of PVSD seem plausible to be definitive,with a favorable prospective application,the long-term follow-up remains to be studied.

关 键 词：室间隔缺损/外科学 心脏导管插入术 胸廓切开术 外科手术 微创性/方法 

分 类 号：R654.2[医药卫生—外科学]