先天性心脏病术后房、室间隔残余分流的介入治疗  

Interventional treatment of post-operation residual atrial or ventricular septal shunt in patients with congenital heart disease

作　　者：肖家旺 王琦光 张端珍 韩秀敏 孟立立 庚靖淞 赵明 朱鲜阳 XIAO Jia-wang;WANG Qi-guang;ZHANG Duan-zhen;HAN Xiu-min;MENG Li-li;GENG Jing-song;ZHAO Ming;ZHU Xian-yang(Department of Congenital Heart Disease,General Hospital of Northern Theater Command,Cardiovascular Research Institute of PLA,Shenyang 110016,China)

机构地区：[1]中国人民解放军北部战区总医院全军心血管病研究所先心病内科,辽宁沈阳110016

出　　处：《中国介入心脏病学杂志》2020年第9期500-505,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(81370276)。

摘　　要：目的评价先天性心脏病(CHD)术后房、室间隔残余分流患者介入封堵治疗的临床疗效。方法选取2011年6月—2018年10月中国人民解放军北部战区总医院先心病内科收治的CHD术后房、室间隔残余分流患者,根据超声心动图和心血管造影情况,选择不同类型封堵器进行介入封堵治疗,术后进行常规超声心动图及心电图随访。结果共纳入21例(男13例,女8例)患者,年龄4~53(27.1±16.8)岁,介入封堵治疗距离首次手术时间为1~40(16±12)年,3例患者为房间隔残余分流,18例患者为室间隔残余分流,其中19例患者成功进行封堵,2例患者室间隔缺损修补术后残余分流患者因形状及走行特殊未成功,手术成功率为90.5%。房、室间隔残余分流各有1例为介入封堵术后,其余均为外科修补术后。1例房间隔缺损修补术后残余分流患者因缺损靠近下腔静脉,在3D打印技术指导下应用动脉导管未闭封堵器进行封堵。所有患者术中均未发生严重心律失常及明显瓣膜反流,仅2例室间隔残余分流患者术后即刻造影显示有微量分流,但3个月随访时,复查超声心动图提示残余分流消失。19例成功介入封堵患者随访39(19,56)个月,均未发现封堵器移位、瓣膜反流、残余分流、严重心律失常、血栓及感染性心内膜炎等并发症发生。结论经导管封堵治疗CHD术后房、室间隔残余分流患者安全、有效,介入封堵治疗后中长期随访效果良好,是一种可行的治疗方法。Objective To evaluate the clinical efficacy of transcatheter closure of post-operation residual atrial or ventricular septal shunt in patients with congenital heart disease(CHD).Methods The patients with residual atrial or ventricular septal shunt who underwent transcatheter closure admitted to Department of Congenital Heart Disease in General Hospital of Northern Theater Command from June 2011 to October 2018 were selected.According to echocardiography and electrocardiogram,diff erent types of occluders were selected for blocking treatment,routine echocardiography and electrocardiogram follow-up were performed after operation.Results Twenty-one patients[13 males and 8 females,4–53(27.1±16.8)years old,time from intervention to fi rst operation 1–40(16±12)years]with atrial or ventricular septal residual shunt were enrolled,including 3 cases with atrial septal residual shunt and 18 cases with ventricular septal residual shunt.A total of 19 patients were successfully occluded,and 2 patients with residual shunt of ventricular septum failed because of their special shape,the success rate was 90.5%.Except 2 cases of residual shunt after interventional therapy,the rest were all of residual shunt after surgery.The edge of residual atrial septal shunt was close to inferior vena cava in one post-surgery patient,and under the guidance of 3D printing technique,PDA device was used successfully to close the defect.Trace residual shunt was founded by immediate radiography in 2 cases of residual ventricular septal shunt,and no obvious valvular regurgitation was founded.The residual shunt disappeared at three-month follow-up.During a median of 39(19,56)months,there was no device embolization,valve regurgitation,residual shunt,severe arrhythmia,the thrombus or infective endocarditis for 19 successful patients.Conclusions Transcatheter closure of residual atrial or ventricular septal shunt is safe,eff ective and associated with a good long-term outcome,which is a practical treatment for these patients.

关 键 词：先天性心脏病 介入封堵治疗 外科修补术 残余分流 

分 类 号：R541.1[医药卫生—心血管疾病]