小儿经胸微创封堵室间隔缺损783例中远期结果的单中心回顾性分析  

Minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects in 783 children:A retrospective analysis in a single center

作　　者：卢绪宁 刘宇航 朱全伟 王宁 文平 LU Xuning;LIU Yuhang;ZHU Quanwei;WANG Ning;WEN Ping(Department of Heart Center,Children’s Hospital of Dalian Medical University,Dalian,116012,Liaoning,P.R.China)

机构地区：[1]大连医科大学附属大连市儿童医院心脏中心,辽宁大连116012

出　　处：《中国胸心血管外科临床杂志》2022年第9期1161-1165,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结食管超声引导下经胸微创封堵小儿室间隔缺损(ventricular septal defect,VSD)的临床经验及中远期随访结果。方法回顾性分析2011年7月—2020年1月大连医科大学附属大连市儿童医院收治的783例小儿VSD的临床资料及中远期随访结果,其中男463例、女320例,手术年龄5个月~13岁,平均(3.3±1.2)岁;体重5.9~51.0(15.9±8.3)kg。所有患儿均行食管超声引导下经胸微创VSD封堵术。其中膜周部VSD 598例,高位VSD 183例(其中合并主动脉瓣脱垂135例),肌部VSD 2例。VSD直径:左室面分流口5.0~11.0(6.3±1.2)mm;右室面分流口2.3~8.0(4.3±0.9)mm。结果753例(96.2%)术中封堵成功,其中1例(0.1%)封堵术后4 h封堵伞脱落嵌于右肺动脉,急诊体外循环(cardiopulmonary bypass,CPB)下切开主肺动脉取出封堵器,同时直视下心包补片修补VSD;1例(0.1%)术后2年出现Ⅲ°房室传导阻滞,再次行CPB下取出封堵器,同时行VSD修补,术后逐渐恢复窦性心律;8例(1.1%)术后1周出现迟发性心包积液,均行超声引导下心包穿刺置管引流术治愈;32例(4.3%)存在残余分流,术后随访过程中均完全自愈;27例(3.6%)术后出现不完全性右束支传导阻滞;19例(2.5%)新发微量三尖瓣反流。选用膜周部对称伞580例,偏心伞171例,肌部伞2例,其中双伞封堵2例。随访时间9个月~9年,随访率96.7%(704/728)。随访期间患儿无死亡,封堵伞无移位,无严重心律失常发生,瓣膜反流无加重。结论小儿经胸微创封堵VSD是一种简单有效的治疗方法,安全性高,中远期随访结果满意,值得临床推广,但需要更远期随访观察。Objective To summarize the minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects(VSD)under transesophageal echocardiography(TEE)guidance.Methods We retrospectively analyzed the clinical data and medium-long-term follow-up results of 783 patients who undertook perventricular device closure under TEE guidance in Dalian Children’s Hospital from July 2011 to January 2020,in which perimembrane VSD were found in 598 patients,VSD with aortic valve prolapse in 135 patients and muscular VSD in 2 patients.There were 463 males and 320 females at age of 5 months to 13 years with average age of 3.3±1.2 years,and body weight of 5.9-51.0(15.9±8.3)kg.The left ventricular defect diameter of the VSD ranged from 5.0 to 11.0 mm,with an average of 6.3±1.2 mm.The right ventricular defect diameter of the VSD ranged from 2.3 to 8.0 mm,with an average of 4.3±0.9 mm.Results The procedures were completed successfully in 753 patients.The device of 1 patient(0.1%)fell off and embedded in the right pulmonary artery after the operation,and the occluder was taken out and the VSD was closed with cardiopulmonary bypass(CPB)in the secondary operation.One patient(0.1%)appearedⅢdegree atrioventricular block in 2 years after operation.The device was taken out and VSD was closed with CPB in the secondary operation,and the patient gradually reached to sinus rhythm in post-operation.Eight patients(1.1%)presented delayed pericardial effusion in 1 week after operation,and were cured by pericardiocentesis with ultrasound-guided.Symmetric occluders were used in 580 patients,eccentric occleders were used in 171 patients and muscular occluders were used in 2 patients.The follow-up time was 9 months to 9 years.The rate of loss to follow-up was 96.7%(704/728).No residual shunt,occlude-loss or arrhythmia was found during follow-up.Conclusion The minimally invasive penventricular device closure of VSD guided by TEE is safe and availabe.Medium-long-term follow-up results are satisfactory,

关 键 词：先天性心脏病 室间隔缺损 微创手术 心脏外科手术 

分 类 号：R726.5[医药卫生—儿科]