肌部室间隔缺损封堵剖析

目的:探讨肌部室间隔缺损封堵的超声心动图筛选适应证及价值。方法:应用HPsonos1500和5500彩色超声诊断仪检查12例拟行封堵术的患者,观测左右室侧缺损口大小、缺损残端距主动脉瓣和三尖瓣的距离。结果:9例封堵成功,左右室侧缺损口大小差异显著,分别为8.5±2.6（6.0～14.0）mm及6.1±1.2（4.0～7.0）mm,残端距主动脉右瓣距离6.0～13.0mm,距三尖瓣7.0～15.0mm,室缺多位于室间隔中部或调节束上方。3例封堵不成功,2例室缺口较大且左右室面大小相同,位于右室流入道部,放置封堵器时因出现Ⅲ度房室传导阻滞而放弃。另1例右室侧缺损口过小,造成穿隔失败。结论:用超声心动图筛选适应证对肌部室间隔缺损封堵成功与否有重要的作用。     

经皮介入封堵治疗小儿心尖部肌部室间隔缺损2例

室间隔缺损是小儿最常见的先天性心脏病之一,其中肌部室间隔缺损(muscular ventricular septal defect,mVSD)是室间隔缺损中较为少见的一种类型,约占5%~20%,其特点是缺损边缘完全为室间隔肌肉,缺损位置多变,可发生于心尖部、流入道、流出道和小梁间隔,其中以心尖部最常见。目前,经导管介入封堵mVSD已成为可替代外科开胸的治疗方法,但经导管介入治疗难度较大,特别是心尖部mVSD,操作复杂,对术者技术要求高。柳州市妇幼保健院近期应用国产mVSD封堵器成功治疗2例小儿心尖部mVSD,现报道如下。     

应用Amplatzer室间隔缺损封堵器经导管逆向关闭肌部室间隔缺损一例

先天性肌部室间隔缺损的外科修补并发症及死亡率均较高。人们已尝试了多种装置以期替代外科经导管关闭这类缺损 ,但因先前的一些装置递送鞘大 ,不能回收及再定位 ,残余分流率高 ,其临床应用受到限制。Ａｍｐｌａｔｚｅｒ室间隔缺损封堵器专为经导管关闭肌部室间隔缺损而设计 ,国外也已有成功应用于儿童患者的个例报道[1] 。本文报告成功应用该装置经导管逆向关闭儿童肌部室间隔缺损的方法学和疗效。患儿女性 ,5岁 ,生后体检偶然发现心脏杂音 ,平时无活动后气促 ,无紫绀 ,无屡患呼吸道感染 ,营养发育好 ,胸骨左缘 3～ 4肋间闻及Ⅲ /Ⅵ级全收…     

室间隔缺损封堵术致眼底动脉栓塞一例

患者女,17岁,因＂发现心脏杂音、室间隔缺损（VSD）17年＂拟行介入治疗,于2008年10月3日入住吉林大学中日联谊医院。查体：血压110/70 mmHg（1 mmHg=0.133 kPa）,口唇无发绀,颈静脉无怒张;双肺呼吸音清,未闻及干湿啰音;胸骨左缘第3~4肋间可触及震颤,心界不大,心率72次/min,节律规整,P2〉A2,     

室间隔缺损介入封堵术后传导阻滞14例分析

2005年3月～2005年12月,我院共行室间隔缺损（VSD）介入封堵术157例,术后发生传导阻滞14例。现分析如下。     

室间隔缺损介入封堵术后迟发性感染性心内膜炎一例

目前介入封堵治疗室间隔缺损安全有效，术后感染性心内膜炎（infective endocarditis，1E）罕见，现报道介入治疗术后迟发性IE一例。     

室间隔膜周部缺损封堵术前后的彩超观察和分析

目的:评估彩色超声心动图(彩超)在膜周部室间隔缺损(VSD)封堵治疗前后的应用价值。方法:158例膜周部室间隔缺损患者实施了经导管封堵术。封堵器为国产的镍钛合金制成的双盘片结构封堵器。经胸壁彩超获取心脏切面图像。平均VSD缺损为(5.86±2.96)mm,最小为3mm,最大为17mm。封堵器直径为4～20mm。结果:158例中153例VSD成功封堵,成功率96.8%。未成功的5例中,3例因导管未能通过VSD处,2例因封堵器放置后引起主动脉反流而放弃封堵治疗。153封堵成功的VSD彩超定位准确:包括膜部35例;嵴下型72例,隔瓣后型46例;其中嵴下型VSD的缺损上缘距主动…     

室间隔缺损封堵术后并发溶血1例

室间隔缺损封堵术术后溶血的发生率很低,仅为4%.本院收治女性患儿,术后并发溶血,经过药物治疗后溶血被纠正.     

干下型室间隔缺损封堵失败1例

室间隔缺损(VSD)是一种常见的先天性心脏病,经导管伞片封堵膜部及肌部VSD技术已证明安全有效[1],但对干下型VSD是否可行经导管伞片封堵术,目前存在一定争议.     

创伤性室间隔缺损介入治疗1例

创伤性室间隔缺损临床上较为少见,治疗方法多为外科手术缝合,国内外也有部分术者采用介入封堵的方法成功治疗创伤性室间隔缺损。本文报道了1例采用肌部室间隔缺损封堵器成功治疗心尖部创伤性室间隔缺损的病例,术后患者活动耐量好转,临床效果满意。     

Transcatheter closure of muscular ventricular septal defect using the Amplatzer devices

TECHNIQUE: From November 1997 to June 2002, percutaneous transcatheter closure of muscular ventricular septal defects was attempted in seven patients. Four patients had single and three had multiple defects. Surgical closure was performed in two patients in an attempt to close a perimembranous defect, leaving behind a large apical muscular defect, which was successfully closed using a device in one patient, whilst the second patient succumbed to septicemia/endocarditis 3 weeks after failure of device implantation. One patient had previous pulmonary artery banding and in another intraoperative placement of two Clamshell devices followed by additional transcatheter closure using Gianturco coils in two different sessions was performed. RESULTS: Transcatheter closure of ventricular septal defect was successful in six patients. Three patients underwent closure of their ventricular septal defects using the Amplatzer Septal Occluder and in the remaining three patients. Amplatzer Muscular Ventricular Septal Defect Occluder was used. The median age was 15 months (range 14 months to 10 years) and the median weight was 7.8 kg (range 7-16 kg). The devices were deployed antegradely in all patients. Immediate complete closure was obtained in three patients while two patients had small and one had a large residual following the procedure. The later was due to another multiple muscular septal defect. Transient heart block occurred in one patient during the procedure and another patient developed heart block on day 3 post-procedure. The latter required temporary pacemaker. During the follow up, one patient who had residual multiple muscular defects underwent a successful redo transcatheter closure using two Amplatzer Muscular Ventricular Septal Occluder devices. CONCLUSIONS: We conclude that transcatheter closure of muscular ventricular septal defect using Amplatzer devices is feasible and effective.     

Percutaneous closure of ventricular septal defect with an Amplatzer device

We present a series of 4 patients in whom a ventricular septal defect (VSD) was closed with an Amplatzer muscular VSD device during cardiac catheterization. In one patient with type I truncus arteriosus and subarterial VSD, closure of a wide apical defect was done to allow further surgical correction while avoiding left ventricular ventriculotomy. The second patient had congenitally corrected transposition of the great arteries with complete A-V block and a pacemaker implanted from birth. Our intention was unload the systemic anatomical right ventricle. The third patient had had 3 heart surgeries to correct a double outlet right ventricle. She had a residual ventricular septal defect which was large enough to cause heart failure. The last patient had an isolated muscular ventricular septal defect. Percutaneous closure was successful in all patients, and there were no complications. Percutaneous closure of the defect may be used as a primary procedure, before surgery, or as a complementary procedure after surgery.     

Transcatheter closure of congenital and acquired muscular ventricular septal defects using the Amplatzer device

Surgical closure of congenital or post-myocardial infarction (MI) muscular ventricular septal defect (MVSD) is associated with significant mortality and morbidity; therefore, both surgeons and cardiologists would welcome a safe non-surgical approach. The aim of this study is to report the combined experience of 2 cardiac centers in the transcatheter occlusion of both congenital and acquired MVSDs using the Amplatzer MVSD occluder device (AGA Medical Corporation, Golden Valley, Minnesota). Thirty-two patients underwent attempted transcatheter closure of an MVSD. Nineteen of these patients had congenital unoperated MVSD, twelve had post-MI MVSD and 1 patient had an acquired VSD post-surgical repair of hypertrophic cardiomyopathy. The median age of patients was 11.5 years (range, 0.1 86.0 years) and median weight was 34.5 kg (3.4 123.0 kg). All patients had significant shunt documented by echocardiography with a median Qp/Qs ratio of 1.7 (range, 1.0 5.3). The VSD location was mid-muscular in 14 patients, posterior in 10, apical in 5 and anterior in 3. The systolic pulmonary artery pressure ranged from 10 85 mmHg (median, 34.5 mmHg). The device was implanted successfully in 30 patients. The device size ranged from 6 26 mm (2 of these were ASD devices). There was immediate complete closure of the defect in 15 patients and 14 patients had residual shunt (foaming through the device). The median fluoroscopy time was 56.7 minutes (range, 11.7 146.0 minutes). Complications included: tamponade in 1 patient resulting in death; device malposition in 1 patient requiring surgical removal; severe hemolysis in 2 patients; and transient junctional rhythm in 1 patient. Among the 30 patients with successful implantation, three died in the hospital and 2 died later. On follow-up evaluation, there were no episodes of endocarditis, thromboembolism, hemolysis or wire disruption. We conclude that the Amplatzer MVSD occluder is a safe and effective device for closure of MVSDs up to 14 mm in diameter. Further clinical trials with this device are underway.     

Transcatheter closure of perimembranous ventricular septal defect using an Amplatzer occluder--early results

BACKGROUND: Transcatheter closure of perimembranous ventricular septal defect with the use of an Amplatzer occluder was introduced in 1999, however, clinical experience with this method remains limited. AIM: To assess short-term safety and efficacy of this technique in children. METHODS: Since 2001, nine children underwent transcatheter closure of perimembranous ventricular septal defect in the cardiac centre in Bratislava (Slovak Republic) or in our centre. Patients were selected for the procedure based on the results of transesophageal echocardiography (TEE). Transcatheter closure using the Amplatzer occluder was guided by both TEE and angiography. The follow-up duration ranged from 3 to 22 months, mean 11.5 months. Control angiography was performed in order to detect any leakage through the aortic valve. The end-diastolic left ventricular diameter before and after the procedure as well as the function of the aortic, tricuspid and mitral valves were also assessed. RESULTS: The procedure was effective in all patients. No damage to atrio-ventricular nor aortic valves was observed. Tricuspid regurgitation, present prior to the procedure, markedly decreased following the closure of the defect. The left ventricular end-diastolic diameter significantly (p=0.001) decreased after the procedure. CONCLUSIONS: (1) Perimembranous ventricular septal defect can be safely and effectively closed using a transcatheter Amplatzer occluder. (2) Appropriate selection for the procedure as well as TEE and angiographic guidance during the procedure enable the avoidance of complications. (3) Tricuspid regurgitation is not an absolute contraindication to perform this procedure.     

'Cobra malformation' of an Amplatzer device during percutaneous closure of a ventricular septal defect

A 76-year-old man presented with successfully resuscitated cardiacarrest due to ventricular tachycardia. He was in florid pulmonaryoedema, but maintaining a blood pressure and electrically stable.Past medical history included hypertension and a permanent     

Transcatheter closure of a traumatic ventricular septal defect using an amplatzer™ atrial septal occluder device

A relatively rare occurrence, the incidence of ventricular septal defect (VSD) complicating penetrating cardiac trauma has been reported at 4.5%. Closing such defects may be challenging especially in an unstable patient where cardiopulmonary bypass may exponentially increase the surgical risk. In such patients, catheter‐based device closure is a reliable and effective alternative. We describe case of a 30 year old man who presented with a stab wound to his anterior mediastinum. His injuries involved laceration to right and left ventricles and a VSD. His lacerations were repaired on a beating heart and the VSD was not addressed due to patient hemodynamic instability. The VSD was semi‐electively closed using a 24 mm Amplatzer? device as the patient demonstrated significant left to right shunt. Post‐device closure, the patient developed hemolysis attributed to an intra‐ device residual leak. The hemolysis resolved without any complications by conservative medical management. At latest follow‐up the patient is in NYHA functional class I–II . © 2013 Wiley Periodicals, Inc.