Amplatzer封堵器治疗膜周部室间隔缺损的近期疗效评价

目的　评价新型Amplatzer封堵器治疗膜周部室间隔缺损 (VSD)的近期疗效。方法2 0 0 2年 11月至 2 0 0 3年 11月 ,采用新型Amplatzer膜部VSD封堵器对 4 8例膜周部VSD患者进行封堵治疗。患者中男 2 5例 ,女 2 3例 ,年龄 17岁± 12岁 ( 3～ 4 8岁 )。经胸超声心动图 (TTE)显示VSD的直径 5 1mm± 1 2mm( 3～ 12mm)。所有患者在透视及超声监测下通过建立股动静脉轨道、经右心系统释放封堵器。并分别于术后 1、3、6、12个月通过经胸超声心动图、12导心电图、X线胸片等检查进行随访评价。结果　 4 5例患者封堵器置入成功 ,技术成功率 94 %。术后出现少量残余分流 5例 ( <3mm) ,完全性左束支传导阻滞 1例 ,无其他严重并发症发生。 4 5例患者接受了平均 3 8个月的随访 ( 1～ 12个月 ) ,随访中无封堵器移位、脱落以及瓣膜损伤等并发症发生 ,2例残余分流于随访 3个月时消失。结论　Amplatzer封堵器治疗膜周部VSD近期效果良好。

Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: a short-term evaluation

OBJECTIVE: To evaluate the efficacy of transcatheter closure of perimembranous ventricular septal Defects (VSD) using the new Amplatzer membranous VSD occluder in a short-term follow-up. METHODS: From November 2002 to November 2003, forty-eight patients (25 male, 23 female) with perimembranous VSD underwent an attempt of catheter closure using a new device specially designed for the membranous septum. The mean age of patients was 17 years +/- 12 years (ranged from 3 to 48 years); the mean diameter of VSD measured by transthoracic echocardiography (TTE) was 5.1 mm +/- 1.2 mm (ranged from 3 to 12 mm). Occluder was released through right heart system. All patients would undergo follow-up 1 months, 3 months, 6 months and 12 months after procedures with examination of transthoracic echocardiography, radiography, and electrocardiography. RESULTS: The devices were deployed successfully in 45 patients. there was complete closure in 36 patients immediately, and tiny (< 3 mm) residual shunt in 5 patients. at the follow-up of 3 months, only two of all patients had a tiny residual shunt. Complete left bundle branch block (LBBB) was found in one patients when he was examined in electrocardiograph 2 weeks later, there were no other severe complications. On a follow-up of 1 to 12 months (mean 3.8 months), all patients were demonstrated a great decrease in their left ventricle end-diastolic dimension (LVEDD) (P < 0.05) and no other late complications. CONCLUSION: Transcatheter closure of membranous VSD using this new occluder is safe and effective, the results of short-term follow-up was satisfied. Further clinical trials are underway to assess the long-term results.