微创胸骨下段小切口室间隔缺损封堵术的临床分析

目的 分析总结微创经胸骨下段小切口室间隔缺损（VSD）封堵术的临床应用价值.方法 回顾分析我科2011年5月至2013年5月经胸骨下段小切口微创封堵术治疗VSD的患者50例.术前行经胸超声心动图评估筛选适合封堵的VSD患者,术中行经食管超声心动图再次评估VSD是否适合封堵治疗,并确定封堵器型号,引导封堵器释放,评判封堵效果,出院后对患者进行随访.结果 50 例VSD患者中48 例成功封堵,成功率96%,2 例封堵不成功中转体外循环下修补.随访6～24 个月,无残余漏,心功能改善.结论 在超声心动图（经胸及经食管）配合下,经胸骨下段小切口微创封堵VSD技术不需要体外循环辅助,是一种简单、安全、有效的治疗方法.

Clinical application value of intraoperative device closure of through a minimal inferior median incision

Objective To therapy the ventricular septal defect（VSD） much more better, we analyzed and summarized clinical application value of intraoperative device closure of through a minimal inferior median incision guided by transthoracic echocardiography （TIE）. Methods 50 patients underwent this procedure were enrolled in the study from May 2011 to May 2013. A minimal inferior median incision was performed after full evaluation of the VSD by realtime TIE, and a domestically made device was inserted to occlude the VSD. The size of the oc- cluder was determined by means of transthoracic echocardiographic analysis. Results Implantation was uhimately successful in 48 patients, 2 patients were converted to surgical repair under cardiopulmonary bypass. 48 cases have no residual shunt and their heart function were improved after operation during the 6-24 months follow-up periods. Conclusion Guided by transesophageal echocardlography, minimally invasive transthoracic device closure of VSD without cardiopulmonary bypass is a safe, feasible and effective therapy.