应用新型Amplatzer封堵器治疗膜周部室间隔缺损的初步研究  

Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous ventricular septal defects occluder: initial clinical applications

作　　者：胡海波[1] 蒋世良[1] 徐仲英[1] 黄连军[1] 刘延玲[2] 王浩[2] 吕秀章[2] 王云[3] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院放射科,北京100037 [2]中国医学科学院中国协和医科大学阜外心血管病医院超声科,北京100037 [3]中国医学科学院中国协和医科大学阜外心血管病医院麻醉科,北京100037

出　　处：《中华心血管病杂志》2004年第3期237-240,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨新型Amplatzer室间隔缺损封堵器治疗膜周部室间隔缺损 (VSD)的可行性及近期疗效。方法　 2 0 0 2年 11月至 2 0 0 3年 7月采用新型Amplatzer膜部VSD封堵器对 2 6例 (男 11例 ,女 15例 )膜周部VSD(2 0例合并膜部瘤 )患者进行封堵治疗。患者年龄 3～ 4 0 (16 4± 10 7)岁 ,胸超声提示VSD的直径为 3～ 14 (4 7± 1 0 )mm。在透视及超声监测下通过建立股动静脉轨道、经右心系统释放封堵器 ,并分别于术后 2周、1个月、3个月、6个月进行随访。结果　 2 5例患者封堵器置入成功 ,技术成功率 96 %。术后即刻超声及造影均示完全封堵 2 0例 ,少量残余分流 2例 ,微量残余分流 3例 ,均在 1天至 3个月内消失 ,总完全封堵率为 10 0 %。术后出现完全性左束支传导阻滞 1例 ,但无心肌受损表现 ,余无其他严重并发症发生。 1例嵴内型VSD由于距主动脉瓣较近 ,封堵未成功。结论　应用新型Amplatzer膜部VSD封堵器治疗膜周部VSD是安全有效的 ,近期效果良好 ,但中。Objective To evaluate the feasibility and efficacy of transcatheter closure of perimembranous ventricular septal defects (VSD) using the new Amplatzer membranous VSD occluder. Methods From November 2002 to July 2003, twenty six patients (11 males,15 femles) with perimembranous VSD underwent an attempt of catheter closure using a new device specifically disigned for the membranous septum. The mean age of patients was (16 4±10 7) years (ranged from 3 to 40 years);the mean weight of patients was (44 6±21 1) kg(ranged from 13 to 83 kg);the mean diameter of VSD measured by transthoracic echocardiography(TTE) was (4 7±1 0) mm(ranged from 3 to 7mm).All patients underwent left ventriculography before catheter closure, and underwent closure under TTE or transesophageal echocardiography(TEE) guidance. All patients were followed up at 2 weeks, 1 month,3 months and 6 months after the procedures. Results The devices were deployed successfully in 25 patients. There was complete closure in 20 patients immediatelly,and tiny(<2mm) residual shunt in 2 patients, trace residual shunt in 3 patients.The residual shunt all disappeared within 1 day 3 months follow up period. Complete left bundle branch block(LBBB) was found on electrocardiogram 2 weeks later in one patient,there were no other servere complications. All patients demonstrated a great decrease in their left ventricular end diastolic pressure(LVEDP) and left ventricular end diastolic dimension(LVEDD)( P <0 05). Conclusions Transcatheter closure of membranous VSD using this new occluder is safe and effective, early results are good.Further clinical trials are underway to assess the long term results.

关 键 词：AMPLATZER封堵器 治疗 室间隔缺损 导管插入术 

分 类 号：R541.1[医药卫生—心血管疾病]