超声引导下介入封堵膜周型室间隔缺损伴主动脉瓣脱垂的临床效果  

Echocardiography-guided transcatheter closure of perimembranous ventricular septal defects with aortic valve prolapse

作　　者：陈脉 黄柳柳[1] 蒋春兰[2] 曾德才 郑宝石[1] CHEN Mai;HUANG Liu-liu;JIANG Chun-lan;ZENG De-cai;ZHENG Bao-shi(Department of Cardiac Surgery,The First Affiliated Hospital of Guangxi Medical University,Nanning 530000,China;Department of Cardiac Ultrasound,The First Affiliated Hospital of Guangxi Medical University,Nanning 530000,China)

机构地区：[1]广西医科大学第一附属医院心脏外科,广西壮族自治区南宁市530000 [2]广西医科大学第一附属医院心脏超声科,广西壮族自治区南宁市530000

出　　处：《中国心血管病研究》2025年第2期97-102,共6页Chinese Journal of Cardiovascular Research

基　　金：国家临床重点专科建设项目(2022255)。

摘　　要：目的分析在单纯超声引导下介入封堵先天性膜周型室间隔缺损(pmVSD)伴主动脉瓣脱垂的临床效果及预后的危险因素。方法选取2018年4月至2024年1月广西医科大学第一附属医院心脏外科收治的42例伴有主动脉瓣脱垂的pmVSD、并在超声引导下介入封堵治疗的患者,收集研究对象的一般资料,随访观察术后主动脉瓣和三尖瓣反流的变化,统计主要生存不良事件、主要不良心血管事件。采用Kaplan-Meier法绘制生存曲线及log-rank检验比较随访结果。单因素Cox回归分析主要心脏不良事件发生的危险因素。结果封堵成功率为95.2%(40/42)。生存随访时间(36.6±21.4)个月,无主要生存不良事件发生。术后主动脉瓣反流和三尖瓣反流较术前减轻。不同AVP组免于主要心脏不良事件生存率未达统计学差异。单因素Cox回归分析显示,术前室间隔缺损大小、主动脉瓣脱垂深度,是术后残余分流及不完全性束支传导阻滞发生的危险因素。结论膜周型室间隔缺损伴主动脉瓣脱垂,如果术前评估及介入方法把握合适,在超声引导下行介入封堵治疗,对主动脉瓣影响小,近中期临床效果良好。Objective To investigate the clinical effect of transcatheter closure of congenital perimembranous ventricular septal defect(pmVSD)with aortic valve prolapse under the guidance of echocardiography and the risk factors of adverse events.Methods From April 2018 to January 2024,42 patients with pmVSD with aortic valve prolapse underwent echocardiography-guided transcatheter closure in the Department of Cardiac Surgery,the First Affiliated Hospital of Guangxi Medical University were included.The general data of patients were collected.The changes of aortic valve and tricuspid valve regurgitation were observed during follow-up.The major adverse survival events and major adverse cardiac events were recorded.The Kaplan-Meier method was used to draw the survival curve and the log-rank test was used to compare the follow-up results.Univariate Cox regression analysis was used to analyze the risk factors of major adverse cardiac events.Results The success rate of occlusionwas 95.2%(40/42).The survival follow-up time was(36.6±21.4)months,and no major adverse survival events occurred.The aortic regurgitation and tricuspid regurgitation were reduced after the operation.The survival free from major adverse cardiac events were not different significantly among the different AVP groups.Univariate Cox regression analysis showed that the size of ventricular septal defect and depth of the aortic valve prolapse were the risk factors for postoperative residual shunt and incomplete bundle branch block.Conclusion If the preoperative evaluation and interventional methods are appropriate,transcatheter closure of pmVSD with aortic valve prolapse under the guidance of echocardiography has little effect on the aortic valve,and the short and mid-term clinical results are satisfactory.

关 键 词：室间隔缺损 主动脉瓣脱垂 超声引导 介入封堵 

分 类 号：R654.2[医药卫生—外科学]