经导管介入治疗主动脉瓣下边缘<2 mm的室间隔缺损疗效评价  

Feasibility and safety of transcatheter closure of ventricular septal defect with subaortic rim <2 mm

作　　者：赵立健[1] 韩波[1] 张建军[1] 伊迎春[1] 姜殿东[1] 吕建利[1] 王静[1] 

机构地区：[1]山东大学附属省立医院小儿心脏科,山东济南250021

出　　处：《山东大学学报（医学版）》2017年第8期52-56,共5页Journal of Shandong University:Health Sciences

基　　金：山东省科技攻关项目(2016GSF201101)

摘　　要：目的探讨经导管介入治疗主动脉瓣下边缘<2 mm的室间隔缺损的可行性及疗效。方法回顾性分析2010年5月至2016年5月接受介入治疗的室间隔缺损患者156例临床资料。根据术前超声测量的主动脉瓣下边缘距离分为短边组(<2 mm,n=69)和长边组(≥2 mm,n=87)。对两组治疗效果及术后并发症进行比较,并对短边组介入治疗失败的危险因素等指标进行分析。结果短边组介入治疗成功率78.3%,长边组介入治疗成功率为96.6%,两组差异有统计学意义(P<0.01)。短边组轻微主动脉瓣反流5例,术后心律失常23例,残余分流6例,无机械性溶血发生。长边组轻微主动脉瓣反流1例,心律失常14例,残余分流6例,其中2例出现轻微溶血。短边组Logistic回归分析结果显示,术前合并主动脉瓣脱垂(OR=8.8,95%CI:1.4~54.9,P=0.02)及VSD缺损≥5 mm(OR=11.6,95%CI:2.37~57.11,P=0.003)为介入治疗失败独立危险因素。结论主动脉瓣下边缘<2 mm的VSD介入治疗成功率较低,术前合并主动脉瓣脱垂及缺损≥5 mm患者是介入治疗失败的危险因素,需严格掌握介入治疗适应证。Objective To explore the feasibility and safety of transcatheter closure of ventricular septal defect（ VSD）with subaortic rim less than 2 mm. Methods The clinical data of 156 patients with VSD who underwent percutaneous interventional procedure during May 2010 and May 2016 were retrospectively reviewed. According to the subaortic rim by transthoracic echocardiography,the patients were divided into short rim group（ 〈 2 mm,n = 69） and long rim group（≥2 mm,n = 87）. The success rate and complications were compared. The risk factors of failure in short rim group were studied with Logistic regression analysis. Results The success rate of short rim group and long rim group was78. 3% vs 96. 6%（ P 〈 0. 01）. Complications in the short rim group included trivial aortic regurgitation in 5 cases,heart arrhythmia in 23 cases and trivial residual shunt without mechanical hemolysis in 6 cases. Complications in the long rim group included trivial aortic regurgitation in 1 case,heart arrhythmias in 14 cases,residual shunt in 6 cases and mechanical hemolysis in 2 cases. Logistic regression analysis revealed aortic valve prolapse before procedure（ OR = 8. 8,95% CI： 1. 4-54. 9,P = 0. 02） and defects ≥5 mm（ OR = 11. 6,95% CI： 2. 37-57. 11,P = 0. 003） were independentrisk factors of failure. Conclusion Transcatheter closure of VSD with subaortic rim 〈 2 mm has relatively lower success rate. Short subaortic rim combined with aortic valve prolapse before procedure and defects ≥5 mm were independent risk factors of failure. Therefore,indications of interventional procedure for VSD with short subaortic rim should be strictly selected.

关 键 词：室间隔缺损 主动脉残边 主动脉瓣反流 房室传导阻滞 残余分流 

分 类 号：R725.4[医药卫生—儿科]