经胸超声心动图在膜周部室间隔缺损介入治疗及中远期随访中的应用

目的 评价经胸超声心动图（TTE）在膜周部室间隔缺损（pmVSD）介入治疗及中远期随访中的应用价值。 方法 TTE诊断pmVSD患者302例(男,129),年龄（19 ± 16）岁。术前TTE多切面观查缺损的大小、形态、周边结构、心腔的大小等。术中根据TTE及造影结果,选择合适的国产封堵器封堵。术后2 d、6个月、≥12月行TTE检查随访观察封堵效果。所有患者完成≥12月的随访,其中178(58.9%)例完成≥3年随访。 结果 ①术前TTE,pmVSD左室面大小(10.7 ± 4.6, 2.5～26）mm,右室面主孔大小(3.3 ± 1.5, 1.5～11）mm;检出漏斗型121(40.1%)例、囊袋多孔型134(44.3%)例、囊袋单孔型39(12.9%)例、窗型8(2.6%)例;检出右冠瓣、无冠瓣脱垂分别为17(5.6%)例、12(3.9%)例,三尖瓣腱索附着异常34(11.3%)例,其中前瓣附着点距缺损边缘无距离11例(3.6%);左房、左室明显增大116（38.4%）例;②所有患者均成功封堵,所用封堵器腰部直径(7.3 ± 3.4) mm。③随访结果:术后2 d残余分流31（10.3%）例,术后6个月减少至9（3.0%）例,术后(1～3)年有7（2.3%）例残余分流,术后≥3年有4（2.2%,n = 178）例。所有患者术后新发主动脉瓣返流11例,均为少量,中远期随访无变化;2例患者TR术后由术前少量增加为中量返流,随访1年以上无明显增加,心腔大小正常。术后第二天,93（30.7%）例患者心腔大小回缩正常,术后6个月所有患者心腔大小均回缩至正常。 结论 TTE在pmVSD的介入治疗及中远期随访中具有重要的临床应用价值;经导管pmVSD封堵术安全有效,中远期随访结果良好。     

应用国产对称双盘封堵器经导管治疗膜周部室间隔缺损的临床疗效

目的评价应用国产对称双盘封堵器经导管治疗室间隔缺损的安全性及有效性。方法自2003年3月至2007年7月,对我科689例室间隔缺损患者应用国产对称双盘封堵器经导管进行了室间隔缺损的介入治疗,合并房间隔缺损、动脉导管未闭等均进行了同期治疗。并进行术中,术后第1、3、6个月及每年随访,包括12导联心电图及超声心动图检查,观察并发症的情况（有无房室传导阻滞、封堵器形态、对主动脉瓣及三尖瓣的影响以及有无残余分流等）,评估该方法的安全有效性。结果总体技术成功率为98.8%。因术后脑出血死亡1例,因Ⅲ度房室传导阻滞安装永久性心脏起搏器1例,半年后因三尖瓣中-重度关闭不全转外科手术1例,6例改用Amplatzer偏心伞进行封堵成功;2例封堵失败转外科手术。其余随访期间未出现明显并发症。结论应用国产对称双盘封堵器经导管治疗室间隔缺损术后出现各种与手术有关的并发症的几率较低,具有很强的安全性和可行性,应成为室间隔缺损患者的首选治疗方案,但同时应掌握好适应证,注意三尖瓣关闭不全等并发症的预防。     

国产封堵器介入治疗巨大动脉导管未闭的临床评价

目的应用国产封堵器经导管治疗巨大动脉导管未闭（PDA）并对其疗效进行评价。方法全组27（男8,女19）例,年龄6～54（24±15）岁,主动脉造影示PDA最窄径为13～28（16±4）mm。封堵后即刻和30min行侧位降主动脉造影,术后2d,1、3、6个月分别行超声心动图及X线平片检查。结果24例成功,3例PDA封堵后判断为有阻力性肺动脉高压,放弃治疗。成功的患者中,14例选用国产PDA封堵器,10例选用国产ASD封堵器。术后即刻降主动脉造影检查示,使用ASD封堵器中,有2例微量残余分流,5例少量残余分流,1例少～中量残余分流;PDA封堵器中,有4例微量残余分流,2例少量残余分流。术后30min,ASD封堵器4例微～少量残余分流,1例仍为少～中量残余分流;PDA封堵器仅2例微量残余分流。1例ASD封堵器治疗术后7h发生溶血,治疗72h溶血无减轻迹象,外科开胸取出封堵器并行PDA结扎术。术后2d,超声心动图示PDA封堵器1例微量残余分流,ASD封堵器5例微量残余分流。随访1～6个月,所有左心内径增大的患者均明显回缩,未发现残余分流和导管再通。结论应用国产封堵器经导管治疗直径≥13mm的PDA是一种安全有效地介入方法。     

国产动脉导管未闭封堵器与Amplatzer封堵器在经动脉导管未闭封堵术中应用的疗效比较

目的比较国产动脉导管未闭封堵器与Amplatzer封堵器(美国进口)在经动脉导管未闭(PDA)封堵术中应用的疗效。方法对2006年1月至12月广东省人民医院确诊为PDA的206例患者,110例采用国产封堵器,96例采用Amplatzer封堵器,分别进行PDA封堵术,对比两组的疗效、并发症和费用等情况。结果国产组109例封堵成功(成功率99.1%),进口组95例封堵成功(成功率99.0%)。两组PDA术前各项临床资料指标、手术和X线曝光时间、封堵成功率及住院天数、术后各项并发症发生率比较,差异无显著性意义,两组PDA治疗前后左室舒张末压及心胸比率降低程度差异无显著性意义,治疗总费用国产组明显低于进口组。结论国产PDA封堵器与Amplatzer封堵器相比其疗效、并发症发生率差异无显著性意义,治疗费用低,临床应用前景广泛。     

国产动脉导管封堵器闭合膜周部室间隔缺损的疗效评价

目的评价国产动脉导管（PDA）封堵器闭合膜周部室间隔缺损（VSD）的可行性、安全性及疗效。方法2004年5月至2008年7月,21例先天性膜周部VSD患者[男性10例,女性11例,年龄5～40（21．3±10．2）岁]成功接受了封堵治疗。膜周部VSD的直径均先经经胸心脏彩超检查（TTE）测量,并经左心室造影进一步明确。封堵操作完成10min后再次予TTE及左心室造影评估封堵效果。术后心电监护1周,出院前及出院后1、3、6个月随访复查TTE及心电图。结果21例患者均全部封堵成功,国产PDA封堵器尺寸为6／8～18／20mm。封堵后,2例新出现微量主动脉瓣反流,1例出现少量的三尖瓣反流;3例出现完全性或不完全性右束支传导阻滞,1例出现完全性左束支传导阻滞,1例出现不完全右束支合并间歇性完全性左束支传导阻滞,除2例完全性或不完全性右束支传导阻滞在6个月内随访时未恢复外,其他3例均在出院前恢复正常;4例存在微量残余分流,其中3例在7d后复查超声时消失,另1例在1个月随访时消失。术前TTE估测肺动脉压力为28．0～46．7（33．4±9．2）mmHg,术后肺动脉压力为16．0-30．2（19．2±7．6）mmHg,6个月随访时肺动脉压力进一步下降为15．3-26．7（17．3±6．9）mmHg。结论对部分膜周部室间隔缺损的患者应用PDA封堵器进行封堵是可行的、安全的及有效的。     

国产蘑菇伞形封堵器治疗未闭动脉导管15例报告

目的评价国产蘑菇伞形动脉导管封堵器治疗动脉导管未闭(PDA)的即刻和早期疗效.方法15例患者,男4例,女11例,平均年龄23±18(5～65)岁.PDA平均最小直径为4.9(2.5～12.0)min,应用F7～F9长鞘管输送封堵器.结果15例患者均获成功.术后10min动脉造影显示PDA完全堵塞.无并发症.结论应用国产蘑菇伞形动脉导管封堵器经导管封堵术是治疗PDA的有效方法.     

国产封堵器治疗并发重度肺动脉高压的动脉导管未闭

目的评价国产封堵器治疗并发重度肺动脉高压动脉导管未闭（PDA）的可行性及近期效果。方法采用经导管国产封堵器堵闭并发重度肺动脉高压PDA 9例,术后进行经胸超声心动图、X线及心电图复查随访。结果9例均封堵成功;2例术后残余分流,在30 d随访中完全消失;血流动力学及心功能在术后和随访期间均有显著改善。全部病例均无严重并发症。结论应用国产封堵器治疗并发重度肺动脉高压PDA,安全可行,近期效果好。     

应用Amplatzer封堵器经导管治疗动脉导管未闭及房间隔缺损的临床观察

目的探讨应用Amplatzer封堵器介入治疗先天性心脏病（CHD）动脉导管未闭（PDA）及房间隔缺损（ASD）的可行性并评价其疗效。方法44例CHD患者（PDA14例，ASD30例）。其中PDA患者在X线透视及造影监视下植入Amplatzer封堵器；ASD患者在X线透视及经胸超声心动图（TTE）指引下经导管植入Amplatzer封堵器。术后重复TTE、ECG、及X线平片检查以评价疗效。结果全组技术成功率100％。其中1例PDA患者术后2小时出现溶血，经内科保守治疗72小时后好转。术后随访显示肺动脉压力显著下降，PDA患者左心房（LA）、左心室舒张末期内径（LVED）及ASD患者右心室舒张末期内径（RVEDD）均明显回缩。除1例发生溶血的PDA患者6个月后仍存在少量残余分流外，其余病例均封堵完全；术后X线检查显示全部患者心胸比例不同程度缩小及肺血减少。结论应用Amplatzer封堵器经导管治疗PDA和ASD是一种安全简便、疗效可靠的介入治疗方法。     

腰长（3~4）mm封堵器治疗膜周部室间隔缺损出现术后心律失常的临床观察

目的 与腰长2 mm封堵器相比较,分析腰长（3~4）mm室缺封堵器介入治疗膜周部室间隔缺损（pmVSD）术后心律失常的变化。 方法 2008年6月～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。根据室间隔缺损左室造影形态、大小,结合术前TTE检查,个体化选用封堵器。术后监测ECG,复查TTE,观察治疗效果,统计心律失常的发生情况,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,成功率99.2%。所有患者依据选用封堵器的不同,分为短腰组（腰长2 mm）和长腰组[腰长（3~4）mm]。两组手术成功率无显著差异。术后新发心律失常149例,长腰组术后心律失常发生率显著低于短腰组（P<0.05）;其中,室上性心律失常和右束支传导阻滞短腰组发生率显著高于长腰组。短腰组出现3例III°AVB,1例Ⅰ°AVB,长腰组1例Ⅰ°AVB,无III°AVB发生。 结论 pmVSD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。长腰封堵器可使术后室上性心律失常和右束支传导阻滞的发生率更低。     

巨大动脉导管未闭的封堵治疗

目的 评价应用国产封堵器封堵治疗巨大动脉导管未闭（PDA）的疗效.方法 全组17例,男性8例,女性9例,年龄15～43（24.5±11.1）岁.主动脉造影示PDA最窄腰部内径为18～26（25.5±1.8）mm,需采用腰部直径20mm以上的封堵器方可操作成功.术后3d及3个月后复查超声心动图.结果 术前超声诊断,17例中6例合并重度肺动脉高压,17例患者中14例（其中5例合并重度肺动脉高压）封堵成功（操作和临床成功）,成功率为82％（14/17）.16例选用国产特制PDA封堵器,1例26 mm ASD因封堵器位置不能牢固地“站稳”而放弃封堵治疗;1例严重肺动脉高压且左向右分流为主存在少量右向左分流,经封堵试验为阻力性肺动脉高压不适宜治疗;1例术后第2天发生封堵器脱落入降主动脉,经捕获器成功取出体外,但死于误吸（迷走反射引起恶心呕吐）导致的严重肺部感染及感染性休克.封堵成功14例,封堵器直径为22～30（26.5±2.7）mm,术后即刻降主动脉造影检查示9例微量残余分流,均为封堵器中间存在云雾状分流,10 min后重复造影云雾状分流消失.术后3d及术后3个月超声心动图示患者所有左心内径增大均明显回缩,未发现残余分流和导管再通.结论 巨大PDA在可能的范围内尽量争取介入治疗,成功后较普通PDA血液动力学恢复更明显,可获得较好的收益/风险比.     

经导管封堵治疗成人房间隔缺损合并功能性三尖瓣返流

目的 探讨经导管封堵成人房间隔缺损（atrial septal defect, ASD）后能否改善其合并的功能性三尖瓣返流（tricuspid regurgitation, TR）。方法 连续纳入自2019年1月1日～2020年12月31日在空军军医大学西京医院心血管内科经导管封堵的ASD合并功能性TR患者,根据术前超声心动图评估TR严重程度并进行分级,术后6个月进行超声心动图随访,评估功能性TR的改善程度。结果 与合并轻度TR组相比,合并中/重度TR组患者年龄较大（P<0.01）,ASD直径较大,RV直径较大（均P<0.05）,与合并中度TR组相比,合并重度TR组患者年龄较大（P<0.01）,RV直径较大（P<0.05）。封堵前,11例患者合并重度TR,18例患者合并中度TR, 71例患者合并轻度TR;封堵术后6个月,10例患者（91%）由重度TR降至轻度,12例患者（67%）由中度TR降至轻度。所有患者中无轻度TR患者的返流量增加至中度或重度。单变量分析显示,持续性TR与肺动脉直径、右房直径、右室直径、左房直径、左室直径及ASD大小相关。经过多变量分析,以上...     

应用导丝漂流技术介入治疗小儿膜周部室间隔缺损

目的 探讨应用导丝漂流技术经导管介入治疗小儿膜周部室间隔缺损（perimembranous ventricular septal defect，PmVSD）的可行性及安全性。 方法 分析2011年12月～2019年12月于西安交通大学第一附属医院结构性心脏病科行经导管介入治疗的PmVSD患儿资料（n = 256）。按术中建立动静脉轨道的方法，分为常规技术组（n = 132）和导丝漂流技术组（n = 124）。比较两组患者的手术成功率、一次性建立动静脉轨道的成功率、手术时间、术中严重心律失常及术后新发心律失常的发生率、三尖瓣返流（tricuspid regurgitation，TR）等有无统计学差异。 结果 常规技术组手术成功率97.0%（127/132）；导丝漂流技术组手术成功率97.6%（121/124），两组间无统计学差异。一次性建立动静脉轨道成功率导丝漂流技术组高（96.7% vs. 87.4%，P<0.05），手术时间两组间无明显统计学差异。手术成功的患者中，导丝漂流技术组术中严重心律失常发生率低（7.1% vs. 0%，P<0.05）。其中，术中常规技术组发生传导阻滞9例（7.1%），均经调整导管位置后恢复正常；导丝漂流技术组术中无传导阻滞发生。两组术后新发心律失常发生率无明显统计学差异。术后2年随访过程中，常规技术组TR较术前加重2例（3.9%），导丝漂流技术组无新发TR。 结论 应用导丝漂流技术治疗PmVSD安全有效，在建立动静脉轨道过程中，可减少导管、导丝对缺损周围组织的刺激，从而减少术中传导阻滞的发生。     

Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: results of the U.S. phase I trial.

OBJECTIVES: This phase I study attempted to report the initial safety and efficacy results of transcatheter closure of perimembranous ventricular septal defects (PmVSDs) using the new Amplatzer Membranous VSD Occluder (AGA Medical Corp., Golden Valley, Minnesota) in the U.S. BACKGROUND: The most common congenital heart disease is PmVSD. Surgical repair is widely accepted, but still carries a small but definite risk of morbidity and mortality. METHODS: Between October 2003 and August 2004, a total of 35 patients with PmVSD underwent an attempt of transcatheter closure under transesophageal and/or intracardiac echocardiographic guidance. The median age was 7.7 years (range, 1.2 to 54.4 years) and median weight was 25 kg (range, 8.3 to 110 kg). The median Qp/Qs ratio was 1.8 (range, 1 to 4), and the median VSD size as assessed by echocardiography was 7 mm (range, 4 to 15 mm). RESULTS: The attempt to place a device was successful in 32 patients (91%). The median device size used was 10 mm (range, 6 to 16 mm). The complete closure rates by echocardiography at 10 min (transesophageal/intracardiac), 24 h, 1 month, and 6 months (transthoracic) were 47% (15/32), 63% (20/32), 78% (25/32), and 96% (27/28), respectively. The median fluoroscopy time was 36 min (range, 14 to 191 min), and the median total procedure time was 121 min (range, 67 to 276 min). Three patients (8.6%) had serious adverse events of complete heart block, peri-hepatic bleeding, and rupture of tricuspid valve chordae tendineae. No other patient encountered serious adverse events during the follow-up. CONCLUSIONS: Transcatheter closure of a PmVSD is technically feasible and seems safe enough in children over 8 kg in weight to warrant continuation of clinical trials to assess the long-term safety and efficacy.     

Complications associated with transcatheter closure of perimembranous ventricular septal defects

Objectives : To identify the complications associated with transcatheter closure of perimembranous ventricular septal defects (PmVSD) using the Amplazter PmVSD occluder (AGA Medical, USA). Methods : Between October 2002 and November 2006, transcatheter closure PmVSD was attempted in 210 patients and performed in 206 patients. Those patients were followed‐up for 6–24 months (mean, 10.6 ± 3.9 months) to identify the complications. Results : Device implantation was successfully accomplished in 206 of the 210 patients (98%). Serious complications such as high degree atrioventricular block (AV block), infective endocarditis, and device embolization occurred in eight cases (3.8%). Other complications including mild aortic or tricuspid regurgitation, femoral pseudoaneurysm, and femoral arteriovenous fistula occurred in four cases. Conclusions : Transcathter closure of PmVSD can be performed safely and successfully. But further studies should continue to evaluate the potential complications associated with this procedure. © 2008 Wiley‐Liss, Inc.     

Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results

With the development of interventional techniques and devices, transcatheter closure of perimembranous ventricular septal defect has been widely performed. However, there has been a lack of long-term follow-up results about postoperative ECG changes of PmVSD patients. We report our experience of early and late arrhythmias after transcatheter closure of PmVSD with a modified double-disk occluder (MDVO). We performed a retrospective review of 79 patients (47 males, 32 females) between September 2002 and May 2007 who underwent transcatheter closure of perimembranous ventricular septal defect. Symmetric and asymmetric PmVSD occluders were used. The diameter of the evaluated defects ranged from 3 to 12?mm, as measured by TTE and 3 to 15?mm by left ventriculography. Most cases of PmVSD were treated successfully with a single procedure, resulting in a successful closure rate of 97% (77/79 patients). There was no death in any of the patients. After the operation, 79 patients were followed-up for a range of 10–76?months (35.3?±?17.4?months). In this series, 11 cases of incomplete right bundle branch block and five cases of complete right bundle branch block occurred during the early period after operation. During long-term follow-up, these issues declined in prevalence to five and four cases, respectively. Moreover, reversible third-degree AVB occurred during closure or after the procedure, and two of the three patients with reversible AVB received a temporary heart pacemaker implantation. These patients recovered 1?h, 6?days, and 9?days later, respectively. During 10–76?months of follow-up, no complications occurred in any of the patients, including residual shunt, severe aortic valve, or tricuspid valve regurgitation. Device closure of perimembranous ventricular septal defects with a modified double-disk occluder (MDVO) resulted in excellent closure rates and acceptably low arrhythmia rates.     

Safety and efficacy of transcatheter closure of large patent ductus arteriosus in adults with a self-expandable occluder

Most occurrences of large patent ductus arteriosus (PDAs) of ≥10 mm have been surgically closed, and transcatheter closure of these large PDAs was only reported in a few case reports. The present study reviewed our experience in transcatheter closure of such large PDAs with a Chinese self-expandable occluder, which is similar to but much cheaper than the Amplatzer occluder. From July 2000 to January 2008, 23 patients underwent transcatheter closure of large PDA ≥10 mm with this kind of occluder. The mean (SD) age of the patients was 38.0 (15.6) years (range 18–75 years). Radiographs of the chest, electrocardiograms, and echocardiograms were used for follow-up evaluation of the treatment within 1 day, 1 month, 6 months, and then every year after successful closure. The mean (SD) angiographic PDA diameter was 12.8 (2.6) mm (range 10–18 mm) and the mean occluder diameter was 18.0 (2.9) mm (range 16–22 mm). The occluders were delivered successfully and closed the PDA completely in 19 out of the 23 patients. Pulmonary arterial pressures decreased significantly after occlusion in patients with successful treatment: 67.3 (24.7) mmHg (range 29–122 mmHg) before occlusion and 42.3 (22.0) mmHg (range 19–98 mmHg) immediately after the procedure. Radiographs of the chest and echocardiograms showed that the diameters of the left atrium, left ventricle, and the main pulmonary artery decreased, and the ejection fraction (EF) increased at a mean (SD) follow-up of 36.3 (18.7) months (range 6–72 months). No severe complication occurred. The immediate and long-term outcomes suggested that transcatheter closure of PDAs with the native PDA occluder is a safe and effective treatment for adults with large PDA ≥10 mm.     

Subclinical aortic perforation with the infant double-button patent ductus arteriosus occluder.

Modification of the double-button (Sideris) patent ductus arteriosus (PDA) occluder has resulted in a single-strut aortic component rather than the conventional cross-strut design. We report the use of this infant PDA occluder for transcatheter closure in three patients with PDA measuring 2 mm, 3.7 mm, and 4 mm. Subclinical aortic perforation with a small aortic aneurysm developed in two patients 1 year after occluder implantation. The third patient had developed a small aortic aneurysm without perforation at 3-month follow-up. All three patients had a residual shunt and underwent successful PDA surgical closure with aortic aneurysmal repair. Single-strut umbrella designs are not recommended for PDA transcatheter closure.     

国产封堵器介入治疗先天性心脏病53例

目的总结心健^TM封堵器介入治疗房间隔缺损、动脉导管未闭及室间隔缺损的可行性及疗效。方法病人年龄11个月～45岁，体重5～66奴。在X线透视及经胸超声心动图监视下，应用心健^TM封堵器按常规方法行介入封堵术，治疗房间隔缺损29例、动脉导管未闭23例、室间隔缺损合并房间隔缺损1例。房间隔缺损均为继发孔中央型；动脉导管未闭漏斗型9例、管型13例、窗型1例；室间隔缺损为膜周型。结果全组无死亡。即刻成功率98％（52／53），即刻完全封堵率92％（48／52）。1例窗形动脉导管未闭并重度肺动脉高压术后血尿，经药物治疗4日后症状消失；另术后早期少量残余分流3例，Ⅰ度房室传导阻滞4例，Ⅱ度Ⅰ型房室传导阻滞1例，随访1～6个月症状均消失。结论用心健^TM封堵器介入治疗房间隔缺损、动脉导管未闭及室间隔缺损可靠，疗效确切。     

应用国产封堵器治疗儿童大型动脉导管未闭的疗效研究

目的:评价应用国产封堵器经导管治疗儿童大型动脉导管未闭的安全性及有效性。方法:12岁以下大型动脉导管未闭患儿66例,应用国产封堵器经导管进行介入治疗,于术后1、3、6月及每年进行超声心动图等随访,观察有无残余分流及主动脉狭窄等,评估该方法的效果及安全有效性。结果:技术成功率97%。应用目前最大封堵器失败转外科手术1例,由于重度肺动脉高压,试封堵后肺动脉压力无明显改善而放弃治疗1例。手术即刻残余分流率为23%,随访观察1月后为3%,6月后所有64例患儿均无残余分流。结论:国产封堵器经导管治疗儿童大型动脉导管未闭安全可行。