国产封堵器治疗膜周部室间隔缺损的研究  

Research of perimembranous ventricular septal defects treatment by domestic ventricular septal defect occluder

作　　者：肖书娜[1] 尚小珂[1] 张刚成[1] 宋艳清[1] 刘洋[1] 王利军[1] 

机构地区：[1]武汉亚洲心脏病医院心内科,湖北省武汉市430022

出　　处：《中国心血管病研究》2015年第10期893-896,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨国产封堵器治疗膜周部室间隔缺损（PmVSD）的效果.方法 对武汉亚洲心脏病医院2012-2014年512例膜周部室间隔缺损介入封堵术进行回顾性分析.结果 介入治疗成功率93.16％,35例治疗失败.15例因新出现主动脉瓣关闭不全,10例出现中度及以上三尖瓣返流,收回封堵器,中止手术.另10例治疗失败为其他原因（包括室间隔缺损较大,封堵器展开后腰征不满意或存在较大残余分流;建立轨道失败;导丝无法通过主动脉瓣行左室造影;术中出现高度房室传导阻滞;术中导丝激惹左心室反复出现心跳骤停终止手术;麻醉失败;穿刺失败）.封堵术后出现88例并发症,包括2例出现机械性溶血;18例术后3个月仍存在1～2 mm残余分流（3.52％）;16例新出现三尖瓣轻度返流（3.13％）;52例术后出现心律失常（10.16％）;2例外科取出.无死亡、封堵器脱落、心脏压塞及心肌梗死病例.结论 经皮介入封堵膜周部室间隔缺损术具有一定风险,术前严格掌握适应证,术中选择合适的封堵器,出现并发症及时治疗和处理具有重要意义.Objective To discuss treatment effect of perimembranous ventricular septal defects occlusion by domestic made ventricular septal defect occluder. Methods To retrospectively analyze 512 patients in Wuhan Asia Heart Hospital from 2012 to 2014 which had accepted transcatheter closure of perimenberanous ventricular septal defect. Results The success rate of transcatheter closure was 89.26%, 55 cases were failed. There were 15 cases with recent aortic regurgitation, 10 cases with recent moderate or more than moderate tricuspid regurgitation, the occluders were taken out and the interventional operation was finished. The reasons for the left 10 failed cases were the sizes of the VSD were big and the waist signs were not good or leaving big residual shunt after opening the occluders. Failed to establish the track, the guild wire could not get through the aortic valve, left ventricular was stimulated by the guild wire and cardiac arrested repeatedly so as to stop the operation, anesthesia failure, puncture failure. There were 88 complications after closure：2 patients had mechanical hemolysis, 18 patients had residual shunt 3 months after the operation（3.52% ）, 16 cases had recent mild tricuspid regurgitation （3.13%）, 52 cases had arrhythmia, 2 of them accepted the surgery of taking out the occluders. There were no death, shedding of occluder, cardiac tamponade and myocardial infarction cases. Conclusion There are risks in percutaneous interventional occlusions, being strict to the indications, selecting suitable occluders during the operation and dealing with the complications immediately is of great importance.

关 键 词：室间隔缺损 介入封堵术 治疗效果 

分 类 号：R541.1[医药卫生—心血管疾病]