多出口膜部囊袋型室间隔缺损的封堵治疗：安全有效性分析

目的：探讨国产小腰大边型封堵器治疗膜部囊袋型多出口室间隔缺损介入治疗的可行性、安全性和疗效,总结其技术难点和治疗策略的选择。方法：20例膜部囊袋型室缺患者,左前斜位45°~60°加头位20°~25°行左室造影,测量室间隔缺损左室面入口直径7~21(10.9±5.2)mm,右室面均有2个或2个以上出口,最大出口直径3~10(4.8±2.9)mm。根据经胸超声和造影的结果判断囊袋的大小、形态、位置、囊袋组织粘连程度、稳固性,植入不同类型小腰大边型堵闭器,封堵器直径为5~14(4.6±2.8)mm。封堵15 min后重复左心室造影和胸超声,观察堵闭即刻效果。术后住院5~7 d,术后1,3,6, 12个月复查心脏超声和心电图,服用拜阿司匹林片6个月。结果：20例患者17例采用国产小腰大边封堵器封堵左室面入口封堵成功,2例采用对称性封堵成功,1例失败。术中堵闭后均未影响主动脉瓣及三尖瓣的功能。术中出现左束支传导阻碍滞1例,右束支传导阻滞1例,经用激素治疗,1周内均恢复。6个月后心超声复查心脏均有不同程度缩小。结论：对膜部囊袋型多出口室缺使用国产小腰大边型堵闭器堵闭安全可靠,疗效肯定。技术的关键根据囊袋的大小,形态、牢固性、出口方向、入口大小、主动脉侧残端大小确定封堵部位和选择合适的堵闭器。

Clinical application study on interventional occlusion for patients with more exports sac-type membranous ventricular septal defection

OBJECTIVE: To investigate the feasibility, safety and efficacy of domestic small waist big edge-type occluder for patients with multiple outlets sac-type membranous ventricular septal defection (VSD), and summarize its technical problems and the choice of treatment strategies. METHODS: A total of 20 patients with sac-type membranous VSD, underwent left ventricular angiography at left anterior oblique 45°-60° plus CAOD 20°-25°; the left ventricular entrance diameters were 7-21 (10.9 ± 5.2) mm, more than 2 outlets in the right ventricular surfaces, and the largest outlet diameters were 3-10 (4.8 ± 2.9) mm. According to the result from transthoracic echocardiography (TTE) and angiography, the sac-bag size, shape, location, extent of tissue adhesion, and stability were determined. Different types of small waist big edge-type occluder were implanted, and the occluder diameter was 5-14 (4.6± 2.8) mm. Following 15 minutes of blocking, the immediate effects of occlusion were observed through repeating left ventricular angiography and TTE. All patients rechecked ultrasonic cardiography and electrocardiogram at 5-7 days of hospital stay, and 1, 3, 6 and 12 months following surgery. All patients took aspirin tablets for 6 months. RESULTS: Of 20 patients, 17 cases underwent domestic small waist big edge occluder, blocked successfully through left ventricular entrance, 2 cases were successful using symmetry block, and 1 case was failed. Intraoperative occlusion did not affect the aortic valve and tricuspid valve function. There were 1 case with left bundle branch block and 1 case with right bundle branch block during the operation, and all recovered within a week by using hormone therapy. After 6 months, the cardiac sizes were reduced to different degrees. CONCLUSION: It is safe and effective to treat multiple outlets sac-shaped membranous VSD with domestic small waist big edge-type occluder. The key technology, according to the sac size, shape, firmness, outlet orientation, import size, and the size of aortic stump, is to determine the block site and to select a suitable occluder.