杂交技术治疗婴幼儿及儿童肌部室间隔缺损——华西医院经验  

Hybrid Perventricular Closure for Pediatric Patients with Muscular Ventricular Septal Defect: Experience from West China Hospital

作　　者：朱达[1] 赁可[1] 冯沅[2] 安琪[1] 唐梦琳[1] 

机构地区：[1]四川大学华西医院小儿心脏中心/心脏大血管外科,成都610041 [2]四川大学华西医院小儿心脏中心/心血管内科,成都610041

出　　处：《中国胸心血管外科临床杂志》2015年第2期118-122,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金青年基金资助项目(81200144)~~

摘　　要：目的探讨应用微创经胸封堵杂交手术治疗婴幼儿肌部室间隔缺损（MVSD）的有效性和安全性。方法回顾性分析华西医院2009~2012年行经胸封堵杂交手术治疗MVSD 35例患者的临床资料,其中男16例、女19例,年龄1个月至7岁,中位年龄3.9岁。包括单发MVSD 10例,多发MVSD 12例,合并其他心内畸形6例,外科术后残余MVSD 7例。结果 35例患儿术后即刻MVSD封堵成功28例（80.0%）,7例（20.0%）残留少量分流,植入封堵器直径中位数5 mm,其中19例患者避免了体外循环。围手术期死亡2例（5.7%）,均因复杂先天性心脏病所致心功能不全导致。术后平均随访6个月,患儿全部生存,31例（93.9%）封堵器位置良好,无残余分流,仅2例（6.1%）存在少量心尖部残余分流。结论经胸封堵杂交技术治疗婴幼儿MVSD具有较高的成功率和较低的死亡率和并发症发生率,短期效果满意。Objective To investigate the efficacy and safety of hybrid perventricular device closure（PVDC） for the treatment of muscular ventricular septal defect（MVSD） in pediatric patients. Methods We retrospectively analyzed clinical data of 35 pediatric patients with MVSD who received hybrid PVDC in West China Hospital between 2009 and 2012. There were 16 males and 19 females with their median age of 3.9 years（range, 1 month to 7 years）. There were 10 patients with single MVSD, 12 patients with multiple MVSD, 6 patients with other congenital heart defects, and 7 patients with post-surgical residual MVSD. Results Among the 35 patients, immediate complete closure was achieved in 28（80.0%） patients. Residual shunt was noted in 7（20.0%） patients. Median device size was 5 mm. Cardiopulmonary bypass was avoided in 19 patients. Two（5.7%） patients died postoperatively due to postoperative heart failure resulted from complex congenital heart defect. All survival patients were followed up for a mean duration of 6 months, and there was no late death. Thirty-one（93.9%） patients had good positioning of the closure devices but no residual shunt. Small residual shunt at the apex was noted in 2（6.1%） patients. Conclusion Hybrid PVDC is an effective treatment for MVSD with relatively high successful rate but low mortality and morbidity, and its short-term results are satisfactory.

关 键 词：先天性心脏病 肌部室间隔缺损 经胸封堵术 杂交手术 

分 类 号：R726.5[医药卫生—儿科]