不同类型膜周部室间隔缺损经皮介入封堵术的疗效分析

目的探讨不同类型膜周部室间隔缺损（室缺）经皮介入封堵术的疗效。方法2011年9月～2012年12月，对89例膜周部室间隔缺损行介入封堵术。通过左心室、主动脉造影及经胸超声心动图检查进行诊断分型，隔瓣下室缺30例，膜部室缺10例，偏流出道室缺29例，嵴内室缺20例。均采用经皮介入封堵术。结果介入治疗成功率96．6％（86／89），其中隔瓣下室缺96．7％（29／30），膜部室缺100．0％（10／10），偏流出道室缺96．6％（28／29），嵴内室缺95．0％（19／20）。3例介入治疗失败，2例因主动脉瓣右冠瓣脱垂伴主动脉瓣中～重度反流而术中停止介入手术；1例术后封堵器移位外科手术取出。4个分型的并发症发生率分别为26．7％（8／30），10．0％（1／10），6．9％（2／29），5．O％（1／20）。3例（3．4％）术后存在1～1．5mm残余分流；4例（4．5％）术后出现瓣膜功能异常，其中2例主动脉瓣轻度反流，2例三尖瓣轻～中度反流，均未行特殊处理，其中3例术后3个月经胸超声心动图复查瓣膜功能恢复正常，1例术后1年复查仍存在三尖瓣轻度反流，但各房室大小及心功能均正常；4例（4．5％）术后房室传导阻滞，经激素及营养心肌药物治疗1周后恢复术前状态。结论不同类型膜周部室间隔缺损经皮介入封堵术安全有效。术前严格掌握适应证，术中选择合适的封堵器是不同类型膜周部室间隔缺损经皮介入封堵术成功的关键。

The Analysis of the Effect of Percutaneous Interventional Occlusion on Different Types of Perimembranous Wentricular Septal Defect

Objective To analyze of the effect of percutaneous interventional occlusion on different types of perimembranous ventrieular septal defect （PmVSD）. Methods From September 2011 to December 2012, the clinical data on 89 PmVSD patients who received percutaneous interventional occlusion was reviewed. The diagnose on different kinds of PmVSD was determined by the left ventricular, aortic angiography and chest echoeardiography（TTE） , including 30 cases of septal subarterial ventrieular septal defect, 10 cases of ventrieular septal defect in pars membranacea, 29 cases in outflow tract and 20 cases of intracristal ventricular septal defect. All cases were treated with percutaneous interventional occlusion. Results The total success rate of the interventional occlusion was 96.6% （86/89）. Of them, the success rate of septal subarterial ventricular septal defect was 96.7% （29/30）, ventricular septal defect in pars membranacea 100.0% （10/10） , ventricular septal defect in outflow tract 96.6% （28/29） and ofintraeristal ventricular septal defect 95.0% （19/20）. Three cases failed and the interventional occlusion for 2 cases stopped during the operation due to aortic right coronary cusp prolapse with aortic valve to severe reflux, and 1 case received another surgery because of occluder device displacement, The complication occurrence rate of the four types were 26.7% （8/30） , 10.0% （ 1/10 ） , 6.9% （ 2/29 ） and 5.0% （1/20） respectively. The postoperative complications included： 3 cases （3.4%） of mild residual shunt; 2 cases of mild aortic valve regurgitation and 2 cases of tricuspid valve mild to moderate regurgitation. Without receiving special treatment, TTE examination proved the valve function of the 3 cases returned to normal in 3 months. 1 case still suffered mild tricuspid valve regurgitation 1 year after interventional occlusion,but the size of the compartments and cardiac function were in normal state. Four cases （4.5%） suffered from postoperative atrioventricular block and returned to preoperative condition 1 week after being treated with hormone. Conclusions The interventional occlusion of PmVSD is a safe and effective treatment. For best results, it is important to strictly control the indicatio of interventional occlusion and to choose proper occlude device for different types of PmVSD.