经导管封堵先天性心脏病术后室水平残余分流的临床应用  

Transcatheter Closure of Residual Ventricular Septal Defect after Surgical Treatment of Congenital Heart Disease or Interventional Therapy of Ventricular Septal Defect

作　　者：李世国[1] 刘琼[1] 闫朝武[1] 胡海波[1] 徐仲英[1] 郑宏[1] 金敬琳[1] 宋会军[1] 吕建华[1] 万俊义 徐亮[1] 张戈军[1] 潘湘斌[1] 蒋世良[1] LI Shi-guo;LIU Qiong;YAN Chao-wu;HU Hai-bo;XU Zhong-ying;ZHENG Hong;JIN Jing-lin;SONG Hui-jun;LV Jian-hua;WAN Jun-yi;XU Liang;ZHANG Ge-jun;PAN Xiang-bin;JIANG Shi-liang(Department of Structural Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院结构性心脏病中心,北京市100037

出　　处：《中国分子心脏病学杂志》2020年第3期3378-3381,共4页Molecular Cardiology of China

基　　金：国家自然科学基金(81670289)。

摘　　要：目的评价经导管封堵先天性心脏病(先心病)外科矫治术后及室间隔缺损封堵术后室水平残余分流的安全性、有效性以及中长期随访结果。方法回顾性分析2011年1月至2019年12月我院收治的35例先心病术后室水平残余分流患者的临床资料,结合介入封堵治疗情况和随访结果进行描述性分析。结果35例患者中23例合并室间隔膜部瘤,其中6例右室面有两处或多发破口。34例封堵成功,其中4例采用2枚封堵器进行封堵。所封堵的右室面破口直径3~10.2 mm,平均(4.89±1.58)mm。所选择的封堵器直径5~20 mm,平均(9.16±3.59)mm,封堵器直径较缺损直径大1.8~10.4 mm,平均大(4.29±2.39)mm。封堵成功的患者中,31例随访1~51个月,与封堵术前相比,患者术后末次随访的左心室舒张末期内径、左心房内径及心胸比均有降低(P<0.05)。所有随访患者术后均未出现房室传导阻滞、感染性心内膜炎、封堵器脱落、主动脉瓣中大量反流及死亡等严重并发症。结论经导管介入封堵术治疗先心病术后室水平残余分流是一种安全有效的方法,中长期随访效果良好,应成为此类患者首选的治疗方法。Objective To evaluate the clinical safety,efficacy and mid-and long-term outcome of transcatheter closure of residual ventricular septal defect(VSD)after treatment of congenital heart disease.Methods Between January 2011 and December 2019,35 patients(25 males and 10 females),aged from 4.5 to 59 years with residual VSD were enrolled in this study.34 patients received surgical treatment and transcatheter closure of VSD was performed in 1 patient previously.Results 23 patients were accompanied with aneurysm of interventricular septum.The mean diameter of the residual VSDs in the right ventricular side was 3-10.2 mm,with a mean diameter of(4.89±1.58)mm measured by left ventricular angiogram.34 patients were successfully performed with transcatheter closure of the residual VSD.In 1 patient,the procedure was failed due to severe aortic regurgitation after the device was deployed.The mean diameter of the devices was(9.16±3.59)mm.There were no procedure-related adverse events.31 patients of the successful procedure were followed up from 1 to 51 months.All the patients were clinically well.Compared with the pre-procedure data,the size of left ventricle and left atrium was decreased with statistically significant difference during the follow-up(P<0.05).There were no atrioventricular block,infective endocarditis,device embolism,severe aortic regurgitation or death in any of the patients during follow-up.Conclusion Transcatheter closure of residual VSD after treatment of congenital heart disease is safe and effective with good follow-up results.

关 键 词：残余分流 先天性心脏病 介入治疗 随访 

分 类 号：R654.2[医药卫生—外科学] R726.5[医药卫生—临床医学]