应用Amplatzer封堵器治疗室间隔缺损及对心脏传导系统的影响

目的　探讨新型Amplatzer室间隔缺损封堵器治疗膜周部及肌部室间隔缺损 (VSD)的疗效和对心脏传导系统的影响。方法　 2 0 0 3- 0 7～ 2 0 0 4 - 0 4采用新型Amplatzer膜部及肌部VSD封堵器对 12例膜周部VSD和 2例肌部VSD患者进行封堵治疗。对心脏多普勒超声检查符合导管封堵条件病人术前常规进行心导管检查 ,测定血流动力学各项参数。在X线透视、食管或经胸超声的监测下建立股动静脉轨道 ,经右心系统释放封堵器。对 12例膜周部VSD病人在手术前、后进行心内电生理检查 ,测定房室传导时间 (AV间期 )和房室结不应期 ,观察封堵手术对心脏传导系统的影响。病人分别于术后 2周、1个月、3个月、6个月进行随访。结果　 14例患者 (男 8例 ,女 6例 )封堵器置入全部成功。术后即刻超声及造影均示完全封堵 12例 ,微量残余分流 2例 ,均在 1d内消失 ,总完全封堵率为 10 0 %。 12例膜周部VSD病人封堵后即刻AV间期有不同程度的延长 ,其中 3例术后AV间期 >2 0 0ms,1周后心电图检查 2例PR间期恢复正常。封堵前后房室结不应期无明显变化。未出现Ⅱ度以上房室传导阻滞和束支传导阻滞 ,无心肌受损表现 ,无其它严重并发症发生。结论　应用新型Amplatzer膜部和肌部VSD封堵器治疗膜周部和肌部VSD是安全有效的 ,近期效果良好 ,是导     

新型Amplatzer封堵器治疗膜周部室间隔缺损的临床研究

目的探讨新型Amplatzer室间隔缺损封堵器治疗膜周部室间隔缺损(PMVSD)的临床疗效。方法采用新型Amplatzer膜周部室间隔缺损封堵器,对46例PMVSD患者进行封堵治疗。对心脏多普勒超声检查符合导管封堵条件的患者术前常规进行心导管检查,测定血流动力学参数。在X线透视、食管超声心动图(TEE)的监测下建立股动静脉轨道,经右心系统释放封堵器。病人分别于术后24小时、1个月、3个月、6个月进行随访。结果46例患者中除2例因室间隔缺损膜部瘤松软未能成功置入外,其余患者均能正确置放新型Amplatzer封堵器和即刻完全封堵PM-VSD。术后24小时至6个月进行TEE复查,所有患者被完全封堵。结论新型Amplatzer封堵器治疗PMVSD是一种安全、成功率高、近期疗效可靠的介入方法。     

经导管封堵治疗膜部瘤型室间隔缺损的初步临床分析

目的探讨应用国产封堵器经导管封堵合并膜部瘤型室间隔缺损(ventricularseptaldefect,VSD)的临床疗效。方法共12例膜周部VSD合并膜部瘤形成患者,男5例,女7例,平均年龄16.4±10.7岁(3—45岁)。采用国产对称型室间隔缺损封堵器在透视及超声监测下进行VSD封堵术,术后即刻行左室造影、升主动脉造影及经胸超声心动图(TTE)检查验证即刻疗效,术后24小时、1个月、3个月、6个月、12个月行心电图、TTE、X线胸片随访复查。结果 11例患者封堵成功,技术成功率91.6%(11/12),其中包括漏斗状膜部瘤5例,菜花状膜部瘤3例,囊袋状膜部瘤3例。1例囊袋状膜部瘤患者因封堵后仍有直径3mm的中量残余分流,放弃封堵。11例患者中7例术后即刻达到完全封堵;4例术后即刻造影及TTE检查显示少量残余分流,24h后超声检查证实残余分流消失3例,另1例1个月复查时残余分流消失,总完全封堵率达100%。1例患者术后新出现完全右束支传导阻滞,1例患者术后24h出现交界性逸博心律,2天后恢复正常,余无其他严重并发症发生。11例患者平均随访10.2±5.2个月(3~18个月),无封堵器移位、晚发心律失常等并发症发生。结论应用国产封堵器对合并膜部瘤型膜周部室间隔缺损进行介入封堵治疗是可行的,近期临床效果满意。     

经胸彩色多普勒超声心动图在室间隔缺损封堵术中的应用

目的:探讨经胸彩色多普勒超声心动图在室间隔缺损(VSD)封堵术中的应用价值。方法:在经胸超声心动图和数字减影血管造影监测引导下,对18例膜周部及肌部室间隔缺损用Amplatzer VSD封堵器封堵。结果:18例VSD中17例封堵成功,其中3例术中出现主动脉瓣反流,2例残余分流,1例三尖瓣反流,经调整封堵器位置和方向后上述异常即刻消失;1例封堵后5小时封堵伞脱落,急行外科手术取出封堵伞,缝闭缺损。全部病例术中均未出现心率失常等并发症,17例成功封堵者术后随访1年均见封堵器位置正常、稳定,无并发症。结论:经胸彩色多普勒超声心动图在VSD封堵术前、术中及术后随访中有重要作用。     

应用Amplatzer封堵器治疗膜周部室间隔缺损20例

目的:观察应用Amplatzer封堵器经导管介入治疗先天性心脏病膜周部室间隔缺损(PMVSD)的可行性、安全性和疗效。方法:采用Amplatzer封堵器治疗先天性心脏病膜部室间隔缺损20例患者,术前由经胸超声心动图确诊PMVSD,术中经左心室造影明确缺损位置、直径、在透视及超声心动图监视下经导管置入Amplatzer封堵器封堵PMVSD,术后3d、3个月、6个月及1年分别行经胸超声心动图、心电图和X线检查。评价治疗效果。结果:20例VSD病人成功置入Amplatzer封堵器,透视及超声心动图显示即刻完全堵闭。术后出现溶血和三度房室传导阻滞各1例,对症治疗后消失。分别手术后3个月、6个月、1年随访,超声心动图示封堵器位置良好,19例完全闭合,仅1例残余分流,无严重并发症。结论:经导管置入Amplatzer封堵器治疗PMVSD是一种成功率高、并发症少、疗效可靠的介入方法。     

室间隔缺损介入治疗后并发封堵器移位的原因分析

目的探讨经导管介入治疗室间隔缺损（VSD）发生封堵器移位的原因和预防措施。方法介入治疗后封堵器移位患者4（男3,女1）例,3例为膜周部VSD伴膜部瘤,1例为嵴内型VSD,缺损直径分别为13、12、12和10mm,所选用的封堵器分别为16、12mm国产对称型膜部VSD封堵器,14mmAmplatzer膜部VSD封堵器和14mm国产偏心型膜部VSD封堵器。结果4例均一次性封堵成功。术后即刻均无残余分流。2例在术后4和12h分别发生溶血,超声心动图检查封堵器位置无明显变化,但均有明显残余分流。经药物治疗后,溶血恢复正常,残余分流消失。1例术后第4天,心电图检查为Ⅲ度房室传导阻滞,超声心动图发现封堵器明显向囊袋出口移位。转心脏外科手术取出封堵器并修补缺损,术后患者Ⅲ度AVB恢复。1例嵴内型VSD术后2周,超声心动图发现封堵器向右心室移位,有明显残余分流。随访4个月残余分流减少。结论VSD封堵治疗后,封堵器移位与缺损的病理解剖特性有关。多发生在伴有膜部瘤的膜部VSD和嵴内型VSD。     

新型Amplatzer封堵器治疗膜周部室间隔缺损的近斯疗效评价

目的探讨新型Apmlatzer室间隔缺损封堵器治疗膜周部室间隔缺损(VSD)的有效性、可性性,并评价其近期疗效. 方法2002年11月至2003年8月采用新型Amplatzer膜部VSD封堵器对34例膜周部VSD(26例合并膜部瘤)患者进行封堵治疗,男16例,女18例,年龄3～40岁,体重13～83(44.6±21.1)kg,经胸超声(TTE)提示VSD的直径3～14(4.7±1.0)mm.     

室间隔缺损膜部瘤的造影分型及介入治疗方法学研究

目的：结合介入治疗实际对室间隔缺损(VSD)伴膜部瘤形成进行造影分型，并对不同类型膜部瘤的介入封堵方法进行探讨。方法：2002-11～2003-11采用新型Amplatzer膜部室间隔缺损封堵器对32例并发膜部瘤的膜周部VSD行封堵治疗，平均年龄19(3～48)岁。封堵术前常规行左室造影，在经胸超声心动图(TTE)及透视监测下通过建立股动静脉轨道、经右心系统释放封堵器，并于术后1、3、6、12个月随访复查胸片、超声心动图、心电图。     

超声心动图检查在VSD介入封堵术中应用

目的探讨超声心动图检查在室间隔缺损(VSD)介入封堵术的适应证筛选及术中、术后的应用价值.方法对12例施行介入封堵术的患者术前用超声心动图测量VSD之形状与大小,术中进行超声心动图监测,术后以超声心动图随诊.结果 12例患者中,膜周部5例,隔瓣后型3例,膜周嵴下型2例,嵴内漏斗部1例,心肌梗死室间隔肌部穿孔1例.共放置13个封堵器,被封堵的VSD直径为3～8mm,平均为(5.2±0.8)mm.10例患者封堵术后即刻观察,穿隔分流消失,术后1周复查,封堵器位置良好、稳定、无残余分流;1例微量残余分流,术后24小时超声心动图复查分流消失;1例少量残余分流,术后即刻复查最大分流速度为1.2m/s(低于险值2m/s),6个月后复查仅见微量残余分流.结论超声心动图检查对介入封堵术的适应证的筛选、确定封堵器释放时间、释放时即刻疗效的评价及术后随访具有重要价值.     

应用Amplatzer封堵器关闭32例膜部室间隔缺损

目的　观察Amplatzer膜部室间隔缺损封堵器关闭膜部室间隔缺损的临床疗效及安全性。方法　经超声心动图及临床表现诊断为膜部室间隔缺损患者 ,如有临床症状但没有右向左分流 ,且膜部室间隔缺损的局部解剖结构满足以下条件 :(1)膜部室间隔缺损离主动脉瓣至少 1mm ,离三尖瓣隔瓣至少 3mm ;(2 )室间隔缺损的最窄直径小于 14mm ;(3)伴膜部室间隔瘤形成时 ,瘤体未影响右心室流出道 ;(4 )外科手术关闭膜部室间隔缺损后遗留的室间隔缺损 ,且对心脏的血流动力学有影响。在局部或全身麻醉下对患者行经导管Amplatzer双面伞膜部室间隔缺损的关闭治疗 ,手术中连续经胸或经食管超声心动图和X线监测。术后随访 3个月。结果　自 2 0 0 2年 6月至 2 0 0 3年 3月共有 32例患者行经导管Amplatzer双面伞膜部室间隔缺损的关闭治疗 ,其中男 17例 ,女 15例。超声测定膜部室间隔缺损直径为 3～ 8mm(平均 5 1mm) ,左心室造影测定膜部室间隔缺损的直径为 3～ 8mm(平均 4 4mm) ,所选Amplatzer膜部室间隔缺损封堵器直径为 4～ 12mm(平均 7 6mm)。堵闭操作技术成功率为 10 0 %。超声心动图示术后即刻残余分流为 11 5 % (少量分流 3 8% ,微量 7 7% ) ,2 4h后残余分流为 7 7% (为微量 ) ,3个月后有 3 8%的微量分流。手术中出现一过性     

Traumatic ventricular septal defects

Two previously unreported cases of traumatic ventricular septal defect are presented. One, which is an unusual occurrence, has been diagnosed on clinical evidence as a ventricular septal defect resulting from a gunshot wound of the chest. The defect has been successfully repaired in one of the patients. The etiology, prognosis and indications for operation in these cases are briefly discussed.     

Small ventricular septal defects in adults

Aims To establish the frequency of complications in adults withsmall ventricular septal defects, which have not undergone surgery. Methods and Results One hundred and eighty-eight adults aged17–72 (mean, 29·2) years with a small ventricularseptal defect were studied. They were referred to a nationalcardiac centre (National Heart Hospital) and specialized grown-upcongenital heart unit. One hundred and thirty-eight were examinedin 1994–95. Fifty patients (26·6%) had additionalcardiovascular lesions, most commonly a bicuspid aortic valveand/or coarctation. Spontaneous closure occurred in 19 (10%)between the age of 17 and 45 (mean, 27) years. Twenty-one (11·2%)had infective endocarditis. Aortic regurgitation developed in37 (19·7%) patients; it was severe in nine. Atrial arrhythmias(supraventricular tachycardia or atrial fibrillation) occurredin 12 patients. In four patients, atrial fibrillation producedsevere right-sided congestion with a left ventricular to rightatrial shunt and haemodynamic features suggesting ‘restrictivecardiomyopathy’. Four patients had ventricular arrhythmia.Disproportionate left ventricular enlargement on echocardiographyand/or chest radiography was present in 26 (13·8%) withoutlesions to account for it. Conclusions Eighty nine patients (47%) aged 17–44 (mean,26·8) years had no complications through many years,while spontaneous closure occurred in 19 (10%) during adulthood.Forty-six (25%) had serious compli-cations: infective endocarditis(11%), progressive aortic regurgitation (5%), age-related symptomaticarrhythmias (8·5%) and atrial fibrillation the commonest.Accepting that there may be a referral bias for those with complications,the course of a small ventricular septal defect is not necessarilybenign during adult life.     

Transcatheter closure of ventricular septal defects

Between January and October, 1987, we attempted percutaneous transcatheter closure of seven ventricular septal defects (VSD) in six patients; none of the patients was a candidate for operative management. Patients' ages ranged from 8 months to 82 years (6.0-70 kg); diagnoses included postinfarction VSD (n = 4), congenital VSD (n = 1), and postoperative congenital VSD (n = 2). Indications for VSD closure were shock or respiratory failure (n = 5) or multiple episodes of endocarditis (n = 1). Closure was attempted with a Rashkind double umbrella: VSDs were crossed via the left ventricle and a guide wire was advanced to the right heart, snared with a venous catheter, and used to direct a long sheath (and ultimately the double umbrella) across the VSD. We crossed the VSD in all seven attempts, and a 17-mm double umbrella was successfully placed in each VSD. In the first (postinfarction) patient with the largest (12 mm) VSD, the umbrella embolized after 20 seconds to the pulmonary artery (without reducing flow). The other six umbrellas remained in position, either diminishing or abolishing the left-to-right shunts. Postinfarction patients had increasing VSD shunting over the next several days and died; at postmortem, the umbrellas remained well positioned in the septum, with other VSDs present. All three congenital VSDs had absent or diminished shunts after umbrella closure. These preliminary data indicate that transcatheter VSD closure is feasible in selected cases.     

Echocardiographic evaluation of ventricular septal defects

Ventricular septal defects (VSDs) are the most common forms of acyanotic congenital heart disease accounting for 37% of congenital heart disease in children. A VSD is defined by parts of the ventricular septum involved. There are four major types of VSDs: perimembranous, muscular, outlet, and inlet VSDs. Echocardiography is the most important clinical tool to help diagnose and characterize a VSD. Although most VSDs are clinically nonsignificant or close on their own, echocardiography with Doppler and color flow mapping can be used to provide accurate anatomic and hemodynamic evaluation of VSDs in order to determine if surgical or transcatheter-based intervention is needed. Hence, understanding how to use echocardiography to characterize VSDs is of crucial importance when caring for patients with adult congenital heart disease.