经皮室间隔缺损封堵术介入治疗失败患儿原因分析  

Analysion causeof failed procedure of transcatheteclosure foventriculaseptal defectin children

作　　者：黄梓健 王树水[1] 张智伟[1] 钱明阳[1] 石继军[1] 李俊杰[1] 李江林[1] 谢育梅[1] 

机构地区：[1]广东省人民医院广东省医学科学院广东省心血管病研究所心儿科,广州510100

出　　处：《中华实用儿科临床杂志》2015年第13期1008-1010,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：广东省科技计划项目（20138031800005）

摘　　要：目的总结经皮室间隔缺损（VSD）介入治疗失败患儿情况，分析介入治疗失败原因。方法收集2009年6月至2013年9月广东省人民医院1280例行VSD介入治疗的患儿（年龄13—141个月）资料，其中封堵成功1237例，失败43例（3．36％）。研究失败病例的心脏彩超、造影资料、介入操作方法及外科手术所见，分析介入失败原因。结果43例介入治疗失败患儿中男25例，女18例；年龄13～141（43．0±31．9）个月；体质量10～35（16．30±5．59）kg。失败原因：6例介入治疗前B超将干下型VSD误诊为膜周型或嵴内型VSD；13例选择封堵器过小，比较3种测量VSD大小的方法显示不同测量方法对VSD大小有影响（F=19．134，P=0．001），B超所测VSD大小[（6．48±1．43）mm]与外科所见VSD大小[（7．02±1．08）mm]比较差异无统计学意义（t=1．42，P=0．168），B超所测VSD大小与左心室造影所见[（4．78±1．11）mm]比较差异有统计学意义（t=4．50，P=0．001），左心室造影所见与外科所见VSD大小比较差异亦有统计学意义（t=5．92，P=0．001）。14例封堵器左盘伞影响主动脉瓣出现主动脉瓣反流；3例出现房室传导阻滞或左束支阻滞；2例出现三尖瓣狭窄；5例为膜部瘤样VSD伴多股分流，封堵器植入后出现残余分流。结论B超诊断应避免将干下型VSD误诊为膜周型或嵴内型VSD。伴主动脉瓣脱垂的病例应参考彩色超声所测VSD大小来选择封堵器。毗邻主动脉瓣的VSD，应选择合适的封堵器及改进操作手法避免影响主动脉瓣。Objective To analyze the causeof failed transcatheteclosure foventriculaseptal defect（VSD） in children. MethodOne thousand two hundred and eighty children aged 13 to 141 monthwho underwentranscatheteclosure from June 2009 to Septembe2013 in Guangdong General Hospital were selected. There were 43 failure（3.36%）. The clinical datincluding transthoraciechocardiograph （ TIE）, radiography, interventional approach and surgical findingwere analyzed. ResultForty - three patientincluded 25 male and 18 female. The pa- tients＇ ageranged from 13 to 141 （43.0 ±31.9） monthand theiweighranged from 10 to 35 （16.3 ± 5.59） kg. The causeof failure including doubly committed subarterial VSD misdiagnosed aperimembranouVSD （PMVSD） ointracristal VSD were in 6 patients. The size of occludewatoo small in 13 cases, and there were statistical differencebetween three measurementof size of VSD（ F = 19. 134 ,P = 0.001 ）. The size of VSD measured by lefventriculaan- giography wasignificantly smallethan thameasured by TrE, and there wastatistical difference [ （4.78± 1.11 ） mm v（ 6.48 ± 1.43 ） mm, = 4.50, P = 0.001 ]. The dimension of VSD measured by lefventriculaangiography wasignificantly smallethan thameasured by surgical findings, and there wastatistical difference [ （ 4.78 ± 1.11 ） mm v（7.02 ±1.08 ）mm,= 5.92, P = 0. 001 ]. But, the size of VSD measured by TFE had no significandifference compared with thameasured by surgical finding（= 1.42, P = 0. 168 ）. Aortiregurgitation occurred in 14 cases; atrioventriculablock olefbundle branch block in 3 patients;tricuspid stenosiin 2 caseand residual shunin 5 patients. ConclusionDoubly committed subaiterial VSD may be misdiagnosed aPMVSD ointracristal VSD. In the ca- seof VSD concomitanwith aortivalve prolapse, size of the occludershould be referred to VSD dimensionmeasured by qTE. In the caseof VSD adjacento aortivalve, suitable occludershould be selected and operation techniqueshould be improved to avoid aortiregurgitation.

关 键 词：室间隔缺损 心导管插入术 超声心动图 左心室造影 

分 类 号：R725.4[医药卫生—儿科]