膜部室间隔缺损微创手术封堵初步经验总结

目的 总结通过微创手术经心室行膜部室间隔缺损（VSD）伞片封堵的临床经验，探讨该技术的手术方法和适应证。方法 对48例膜部VSD患儿采用胸下小切口经心室途径封堵治疗。患儿均为膜周限制性VSD，VSD基底部直径2～9 mm；伞腰直径4～10 mm；45例采用同心伞，3例采用偏心伞。在经食管超声心动图的引导下经右心室放入室间隔封堵伞。结果 45例患儿术后心功能稳定，随访1～6个月，伞片位置无移位，无心律失常和残余分流。其余3例患儿发生心律失常，其中1例发生室性早搏和短阵性室性心动过速，2例发生房室传导阻滞，经治疗均好转。结论 经胸小切口行伞片封堵膜部VSD为VSD的治疗提供了一种良好的选择，应严格把握手术适应证。

Preliminary surgical experience of minimally invasive device closure of perimembranous ventricular septal defects

Objective To summarize the clinical experience of minimally invasive perventricular device closure of perimembranous ventricular septal defects (VSD), and explore the surgical techniques and indications. Methods Forty-eight patients with perimembranous VSD underwent perventricular device closure with inferior sternotomy. Restrictive perimembranous VSD were found in all the patients. The basal diameters of VSD ranged between 2 mm and 9 mm, and the diameters of the occlusion device waist ranged between 4 mm and 10 mm. Concentric occluders were used in 45 patients, and eccentric occluders were used in 3 patients. The occlusion device was deployed through right ventricle under echocardiographic guidance. Results Forty-five patients were stable in heart function after operation. Patients were followed up for 1 to 6 months, and there was no position shift of the occlusion devices, arrhythmia or residual shunt. Arrhythmia occurred in the other 3 patients after operation, including ventricular premature beat in 1 patient and atrioventricular block in the other 2 patients. All of these three patients recovered after treatment. Conclusion The perventricular device closure of perimembranous VSD with inferior sternotomy appears to be a favorable choice for the treatment of VSD, while the surgical indications should be carefully managed.