经胸穿刺封堵术治疗干下型室间隔缺损的安全性及有效性研究

目的经胸穿刺封堵术是治疗干下型室间隔缺损的新方法,本研究评估其在干下型室间隔缺损患者中的安全性及有效性。方法纳入2010年11月至2012年5月间华西医院经超声心动图确诊干下型室间隔缺损、年龄小于10岁的患者39例,其中男18例、女21例,年龄(5.9±3.2)岁。经胸封堵采用偏心封堵器,并在经食管超声心动图(TEE)引导下完成。观察围手术期及随访期间患者残余分流、瓣膜反流(如主动脉瓣反流)、心律失常等并发症发生情况。结果共33例成功行经胸穿刺封堵术,中转开胸6例。术后住ICU时间(2.2±0.8)d,住院时间(4.8±1.8)d。术后主要并发症包括残余分流,轻度以下主动脉瓣反流。随访时间(7±2)个月,随访中未发现明显心律失常或中度以上瓣膜反流。结论对于部分解剖形态合适的干下型室间隔缺损患儿,经胸穿刺封堵术安全有效、创伤小,中期随访结果良好。

Safety and Efficacy of Perventricular Device Closure of Subarterial Ventricular Septal Defect

Objective To assess the safety and efficacy of a new surgical strategy, perventricular device closure, for the treatment of subarterial ventricular septal defect （VSD）. Methods Thirty-nine patients younger than 10 years with subarterial VSD who received surgical repair in West China Hospital from November 2010 to May 2012 were in- eluded in this study. There were 18 male and 21 female patients with their age of 5.9± 3.2 years. Perventricular device closure was performed with eccentric device under the guidance of transesophageal echocardiography （TEE）. Residual shunt, valvular regurgitation （including aortic regurgitation） and arrhythmias during perioperative period and follow-up were analyzed. Results Thirty-three patients successfully received perventricular device closure, and 6 patients received conversion to open surgical repair. Postoperative ICU stay was 2.2± 0.8 days, and length of hospital stay was 4.8＋1.8 days. Major postoperative complications included residual shunt and mild or less aortic regurgitation. Mean follow-up dura- tion was 7±2 months. No obvious arrhythmia, moderate or severe valvular regurgitation was observed during follow-up. Conclusion Perventrieular device closure is safe, efficacious and minimally invasive for the treatment of subarterial VSD in pediatric patients with suitable anatomic characteristics with good mid-term results.