经导管封堵主动脉窦瘤破裂

目的探讨经导管介入封堵主动脉窦瘤破裂的临床疗效。方法7例主动脉窦瘤破裂患者,5例为主动脉无冠状动脉窦（无冠窦）破裂至右心房,2例为主动脉右冠状动脉窦（右冠窦）破裂至右心室。对5例患者经同侧的右股动、静脉建立轨道,应用PDA单盘蘑菇伞封堵器进行封堵;对2例患者经同侧右桡动脉及右股静脉建立轨道,置入“细腰大边”的室间隔封堵器。结果7例患者均封堵成功,技术成功率100％;仅2例患者出现微量残余分流,术后2天心脏超声证实完全封闭,无相关并发症。术后1、3、6个月超声心动图显示舒张末期左心室内径均较术前明显改善,封堵器形态、位置良好,无残余分流及主动脉瓣反流。结论介入封堵主动脉窦瘤破裂微创、有效,近期疗效尚满意,中远期的疗效有待进一步随访观察。对于合并心力衰竭或心功能控制不满意的患者,经桡动脉建立轨道是有益的尝试。

Transcatheter occlusion for ruptured sinus of Valsalva aneurysm

Objective To investigate the clinical value of transcatheter occlusion for ruptured sinus of Valsalva aneurysm (RSVA) rupture. Methods Seven patients were enrolled, including 5 with the rupture of noncoronary sinus of Valsalva into right atrium and 2 right coronary with the rupture of the sinus of Valsalva into right ventricle. The arterio-venous wire loop from right femoral artery to right femoral vein in 5 patients and wire loop from right radial artery to right femoral vein in 2 patients were established. Five duct occluders and 2 "thin-waist" shape occluders of ventricular septal defect were successfully deployed by antegrade venous approach. Results The ruptures were all successfully occluded. Small residual shunt was found in only 2 patients, and then disappeared 2 days later. Left ventricular diameter decreased significantly 1, 3 and 6 months after operation than that before operation. The shape and position of occluders remained normal. No device displacement, influence on aortic valve nor residual shunt was found postoperatively. Conclusion Transcatheter occlusion of RSVA is effective. Further clinical trials are underway to assess the long term efficacy. Especially for patients with heart failure, wire loop from radial artery is useful.