经右胸或左胸途径微创封堵膜周部室间隔缺损  

Percardiac device closure of perimembranous ventricular septal defects through a right or left parasternal approach

作　　者：李红昕[1] 郭文彬[2] 张海洲[1] 朱梅[2] 张文龙[1] 王正军[1] 粱飞[1] 

机构地区：[1]山东大学附属省立医院心脏大血管外科,济南250021 [2]山东大学附属省立医院超声诊疗科

出　　处：《中华小儿外科杂志》2015年第8期577-581,共5页Chinese Journal of Pediatric Surgery

基　　金：山东省自然科学基金（ZR2013HM063）

摘　　要：目的报告经右胸或左胸途径微创封堵膜周部室间隔缺损（PmVSD）的方法、可行性和优势。方法右胸组104例、左胸组22例，在食道超声引导下，分别经右胸骨旁第四肋间和左胸骨旁第三肋间小切口进胸。前者应用中空探条输送系统，经右心房、三尖瓣和右心室封堵PmVSD。后者应用直接输送系统，穿刺右心室，封堵PmVSD。选择经胸骨正中途径封堵、与上述患儿相匹配的胸骨1组和2组作为对照。结果经右胸和左胸途径封堵成功率分别为96％和95％。与胸骨组相比，手术时间更短（P〈0．05）。随访中，无封堵器脱落、完全性房室传导阻滞等并发症。结论经右胸或左胸途径微创封堵PmVSD是安全、可行的，创伤更小，更美观。Objective To evaluate the feasibility, safety and efficacy of percardiac device closure of a perimembranous ventricular septal defect （PmVSD） through a right or left parasternal approach. Methods Between May 2011 and June 2014, a total of 104 patients underwent peratrial device closure of PmVSD through a right parasternal approach （right parasternal group）. A 1. 5 to 2 cm parasternal incision was made in the fourth right intercostal space. A specially designed hollow probe was inserted into right atrium and passed through tricuspid valve into right ventricle. Under transesophageal echoeardiographic guidance, the probe tip was adjusted to point to or cross defect. A flexible guidewire was inserted into left ventricle through the channel of probe and a delivery sheath was introduced through defect over wire. Then the device was deployed for closing defect. And another 22 patients underwent perventrieular device closure of PmVSDs through a left parasternal approach （left parasternal group）. A 2 ern parasternal incision was made in the third left intercostal space. A puncture site was chosen and pursestring sutures were placed at right ventricular free wall. After puncture, the device-loaded delivery sheath was inserted into right ventricle and crossed defect directly. The device was deployed subsequently. And 121 matched control patients （sternal groups 1 2） were identified on the basis of patient age, PmVSD and device size. Results The successful occlusion rates of right and left parasternal approaches were 100/104 （96%） and 21/22 （95%） respectively. The mean exit diameters of PmVSDs were 3. 2 ± 1.1（2. 0-7. 0） and 3.0 ± 1.2 （2. 0-6. 0） mm respectively. The mean intracardiac manipulation time was longer in right （ 14 ± 12 min, P〈 0. 05） or left （14 ± 16 min） parasternal group than in sternal groups. But the procedure time was shorter in right （55 ± 17 rain, P〈0. 01） or left （66 ± 27 rain, P〈0. 05） parasternal group than in sternal groups. During a follow-u

关 键 词：室间隔缺损 微创外科手术 心脏外科手术 

分 类 号：R726.5[医药卫生—儿科]