二代Amplatzer动脉导管未闭封堵器在儿童膜周部室间隔缺损治疗中的应用  

Application of Amplatzer duct occluderⅡin treating sick children with perimembranous ventricular septal defect:clinical efficacy and preliminary experience

作　　者：罗刚[1] 泮思林[1] 孙宏晓 王葵亮 纪志娴[1] 杜占慧 LUO Gang;PAN Silin;SUN Hongxiao;WANG Kuiliang;JI Zhixian;DU Zhanhui(Heart Disease Center,Affiliated Women and Children's Hospital of Qingdao University,Qingdao,Shandong Province 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,山东266034

出　　处：《介入放射学杂志》2021年第11期1105-1108,共4页Journal of Interventional Radiology

基　　金：国家自然科学基金(81770316、81970249);泰山学者工程资助项目(2018)。

摘　　要：目的总结二代Amplatzer动脉导管未闭封堵器(ADOⅡ)介入治疗膜周部室间隔缺损(pmVSD)的效果和经验。方法回顾性研究2016年1月至2020年10月青岛大学附属妇女儿童医院采用ADOⅡ介入封堵治疗的15例pmVSD(9例伴发膜部瘤)、1例法洛氏四联症VSD修补术后残余漏、1例pmVSD修补术后残余漏患儿。术后随访观察是否存在残余分流、瓣膜反流和心律失常等并发症。结果17例患儿中男10例,女7例;中位年龄3.25岁(1.7~8.0岁),中位体质量16.0 kg(10.5~31.0 kg);中位室间隔缺损为3.0 mm(2.0~5.0 mm),中位肺血管阻力为1.4 Wood U/m^(2)(1.1~2.2 Wood U/m^(2)),中位肺循环/体循环血流量比值(Qp/Qs)为1.29(1.0~1.7)。11例患儿接受顺行路径释放ADOⅡ,6例为逆行路径,术中均无封堵器脱落、死亡等严重并发症。所有患儿定期随访,随访时间为16.6个月(1~40个月),无完全性房室传导阻滞及主动脉瓣反流。结论pmVSD与残余漏解剖结构多变,选择ADOⅡ介入封堵治疗在减少并发症、保证治疗效果上具有优势,尤其适用于pmVSD伴膜部瘤患儿。完全性房室传导阻滞仍然是术后需持续关注的严重并发症。Objective To summarize the clinical efficacy and experience of using Amplatzer duct occluderⅡ(ADO II)for transcatheter closure of perimembranous ventricular septal defect(pmVSD)in pediatrics.Methods The clinical data of 17 child patients with non-patent ductus arteriosus structural heart disease,who were admitted to the Affiliated Women and Children's Hospital of Qingdao University of China between January 2016 and October 2020 to receive interventional closure therapy with ADOⅡ,were retrospectively analyzed.The heart diseases included pmVSD(n=15,9 patients having associated pseudo theca tumor),residual leakage after VSD repair for Fallo tetralogy(n=1),and residual leakage after pmVSD repair(n=1).Postoperative observation was focused on the complications such as residual shunt,valve regurgitation,arrhythmia,etc.Results The 17 patients included 10 male children and 7 female children.The median age was 3.25 years old(1.7-8.0 years old)and the median body weight was 16.0 kg(10.5-31.0 kg).The median diameter of VSD was 3.0 mm(2.0-5.0 mm),the median pulmonary vascular resistance(PVR)was 1.40 Wood U/m^(2)(1.1-2.2 Wood U/m^(2)),and the median pulmonary circulation/systemic circulation blood flow ratio(Qp/Qs)was 1.29(1.0-1.7).Successful anterograde release of ADOⅡwas accomplished in 11 child patients and retrograde release of ADOⅡin 6 child patients.During operation no serious complications such as occluder falling-off,death,etc.occurred.All child patients were followed up regularly,with a median follow-up period of 16.6 months(1-40 months).No complete atrioventricular block or aortic regurgitation occurred.Conclusion The anatomic features of pmVSD and residual fistula are varied.The use of ADOⅡin interventional closure therapy can reduce complications and ensure a satisfactory therapeutic effect.This technique is especially valuable for child patients with pmVSD complicated by pseudo theca tumor.However,postoperative complete atrioventricular block is a serious complication that requires ongoing concern.

关 键 词：Amplatzer动脉导管未闭封堵器 室间隔缺损 残余漏 介入治疗 儿童 

分 类 号：R725.4[医药卫生—儿科]