封堵器介入治疗膜周部室间隔缺损对瓣膜反流的影响  

Effect of occluder on valve regurgitation in the interventional treatment of perimembranous ventricular septal defect

作　　者：和旭梅[1] 薛建颖 霍晓薇[1] 闫丹丹 杜亚娟[1] HE Xumei;XUE Jianyin;HUO Xiaowei;YAN Dandan;DU Yajuan(Department of Structural Heart Disease,First Affiliated Hospital,Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院结构性心脏病科,710061

出　　处：《心肺血管病杂志》2022年第6期625-629,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨膜周部室间隔缺损(pmVSD)使用国产封堵器介入治疗后瓣膜反流的发生和转归情况。方法:2008年6个月至2014年12月,在我中心确诊的450例pmVSD患者,术前超声心动图(TTE)等检查具有介入封堵指征。根据使用封堵器腰径的长短,分为短腰组和长腰组。行左心室造影,结合术前TTE检查,个体化选择封堵器行介入治疗。术后定期复查TTE,观察治疗效果,统计相关数据,进行比较分析。结果:450例患者造影后均尝试封堵术。444例患者成功行介入封堵治疗,其中短腰组成功219例,成功率97.7%。长腰组225例成功,成功率99.6%。两组手术成功率差异无统计学意义(P> 0.05)。术后新发主动脉瓣轻度反流4例,均为短腰组;9例二尖瓣轻度反流,其中短腰组5例(2.3%),长腰组4例(1.9%);8例三尖瓣反流,其中短腰组5例(2.3%),长腰组3例(1.3%),轻度反流。两组近期瓣膜反流发生率差异无统计学意义(P> 0.05)。中长期随访中,三尖瓣反流、主动脉瓣反流以及二尖瓣反流两组相比均差异无统计学意义。结论:单纯膜周部室间隔缺损介入封堵治疗安全有效,可作为具有适应证患者的首选治疗方法。腰长3~4mm室缺封堵器可取得满意的临床效果。为避免瓣膜功能受影响,应严格把握适应证、个体化选用封堵器,术中应用心脏超声监测,避免操作动作粗暴。Objective: Comparing to 2mm waist-long occluder, analyze valvular function after transcatheter closure of perimembranous ventricular septal with 3-4mm waist occluder. Methods: From the medical database in our center within the period from June 2006 to December 2010, we selected as samples the 450 cases of perimembranous ventricular septal defect(pmVSD). We selected approperiate occluders to do the transcatheter interventional occlusion. After the operation, we reviewed the echocardiography, observed the effect of the treatment, and counted valvular regurgitation as well as made the comparative analysis. Results:OF all the 450 cases, 444 succeeded. Among the successful cases, 219 of them were short waist cases, mission success rate 97.7%;225 of them were long waist cases, mission success rate 99.6%. There was no siginificant difference between two-groups(P>0.05).After transcatheter closure,4 cases had aortic regurgitation, all of which were with short waist;9 cases(short waist: 5 cases, 2.3%;long waist: 4 cases, 1.9%) showed mitral regurgitation,8 cases(short waist: 5cases, 2.3%;long waist: 3 cases, 1.3%)showed tricuspid regurgitation.Comparing to short waist group, the incidence of valvular function in long waist group did not show significant difference(P>0.05). Conclusions: The pure occlusion treatment for pmVSD is safe and effective, and can be the preferential choice for patients who show revelant indications. The interventional therapy by the new type long waist PMVSD occluder showed the same effect with that by the short waist occluder. To reduce the incidence of valvular regurgitation,the indications should be strictly controlled, the occluder should be selected individually, and intraoperative cardiac ultrasound monitoring should be used to avoid rough manipulation.

关 键 词：室间隔缺损 介入治疗 封堵器 

分 类 号：R54[医药卫生—心血管疾病]