经心室穿刺封堵婴幼儿非肌部室间隔缺损39例

目的 探讨经心室穿刺封堵婴幼儿非肌部室间隔缺损(VSD)的临床效果.方法 2007年4月至2008年2月,治疗39例非肌部VSD病儿,男16例,女23例.年龄12～36个月,平均(14.5±7.8)个月;体重8.5～18.0 kg,平均(12.4±2.3)kg.其中膜周部VSD 34例、干下型3例、嵴内型2例.缺损直径3.0～11.0mm,平均(6.1±2.0)mm.均接受非体外循环下经右心室穿刺封堵VSD治疗.结果 全组均无需输血.37例封堵成功,2例因发生中度主动脉瓣反流改行直视手术.置入封堵器直径4～12 mm,平均(8.2±2.0)mm.术后膜周部VSD者中三尖瓣反流程度减轻3例,新出现微量至轻度三尖瓣反流8例;6例出现不完全性右柬支传导阻滞.术后住院3～5 d,平均(3.4±0.4)d.结论 经心室穿刺行VSD封堵术对婴幼儿非肌部VSD而言是一种有效和安全的治疗手段.

Clinical study of perventricular device closure of non-muscular ventricular septal defects in 39 infants

Objiective To evaluate the effect of pearventricular device closure of non-muscular ventricular defercts(VSDs) in infants.Methods From April 2007 to February 2008,39 patients with non-muscular VSDs were received off pump surgical treatment,perventricular device closure were for all the patients.There were 16 males and 23 females with mean age of(14.5±7.8) months(12 to 36 months and mean weight of(12.4±2.3)kg(8.5 to 18.0 kg).There were 34 perimembranous and 5 subateria VSD.The diameter of defects were 3.0 to 11 mm[mean(6.1±2.0)mm].Results Thirty-seven(94.9%)VSDs ere successfully closed,while two were repaired under cardiopulmonary bypass(CPB)instead of device closure because of the complication of moderat aortic reurgitation.The diameter of occluders were 4 to 12mm[mean(8.2±2.0)mm].The tricuspid regurgitations decareasded after operation in 3 patients with perimenmbranous VSDs,while the closure caused new mild or trace tricuspid regurgitations in 8 patients.Six patients with perimembranours VSDs acquired the incomplete right bundle branch blocks affter device closure.The length of hospital stay was 3 to 5 days[mean(3.4±0.4)]after operation and no petient had blood transfusion.Conclustion Perventricular device closure is probably an effective and safe treatment for non-muscular VSDs in unfants.