国产对称双盘状封堵器经导管治疗室间隔缺损21例

目的:分析国产对称双盘状封堵器经导管治疗室间隔缺损（VSD）的疗效。方法:21例,全部为膜部室间隔缺损,年龄3.035.0（7.6±8.4）岁。VSD左室面直径为2.212.0（6.2±4.2）mm。经6F-10F传送鞘置入国产对称双盘状封堵器,封堵后即刻行左心室造影,术后1 d、1、6及12月行超声心动图检查观察有无残余分流。结果:封堵器植入成功20例,植入技术成功率95%。术后即刻左心室造影示4例（20%）存在微少量残余分流,16例（80%）封堵完全无残余分流。术后2448 h超声心动图示分流完全消失19（95%）、微少量残余分流1例（5%）。1例封堵术后3 d发生一过性Ⅲ度房室传导阻滞,经过410 d内科保守治疗治愈。1月超声心动图所有病例未见残余分流。结论:应用国产双盘状封堵器治疗VSD是一种安全有效的介入方法,操作简便,成功率高,近期疗效可靠。     

应用国产对称双盘状封堵器经导管治疗小儿室间隔缺损的疗效评价

目的应用国产对称双盘状封堵器经导管治疗小儿室间隔缺损（VSD）并对其疗效进行初步评价。方法全组446例,其中443例为膜部VSD,3例为肌部室VSD,年龄7±8（2～12）岁。VSD左室面直径为6.8±3.9（2.0～12.0）mm。经6F～10F传送鞘置入对称双盘状封堵器,封堵后即刻行左心室造影,术后1d、1个月、6个月及行超声心动图检查观察有无残余分流。结果全组446例封堵器植入成功,植入技术成功率100%。术后即刻左心室造影示81例（18.2%）存在微～少量残余分流,365例（81.8%）封堵完全无残余分流。术后24～48h超声心动图示分流完全消失410例（91.9%）、微～少量残余分流36例（8.1%）。1例封堵术后24h发生溶血,经过7d内科保守治疗治愈。8例封堵术后3d发生一过性Ⅲ度房室传导阻滞,经过4～10d内科保守治疗治愈。1个月超声心动图发现2例残余分流（0.9%）。结论应用国产双盘状封堵器治疗小儿室间隔缺损是一种安全有效的介入方法,操作简便,成功率高,近期疗效可靠,中远期疗效尚需进一步观察。     

室间隔缺损介入封堵326例经验总结及随访分析

目的 总结经皮导管室间隔缺损介入封堵术的临床经验,并对326例患者的中期随访结果进行回顾性分析.方法 326例室间隔缺损患者均经临床和经胸超声心动图（TTE）确诊,排除干下型室间隔缺损,采取经皮导管室间隔缺损介入封堵术,术后即刻左心室造影和经胸超声心动图检查观察疗效,术后1d、1个月、3个月、6个月、1年、2年、3年、4年、5年行经胸超声心动图、X线胸片和超声心动图检查随访观察.结果 经皮导管室间隔缺损介入封堵成功率为98.3％（320/326）,失败原因为室间隔缺损过大或过小、位置特殊、合并主动脉瓣脱垂及反流、损伤三尖瓣或主动脉瓣、房室传导阻滞等.术后并发症：1例术后1d封堵器移位,急诊心脏外科手术处理;2例8 kg患儿术后股动脉血栓形成,尿激酶溶栓后治愈;12例新出现三尖瓣轻度反流或原有三尖瓣反流增多;1例损伤主动脉瓣致中度反流,急诊外科手术处理;56例出现非阵发性交界性心动过速,经激素、人体白蛋白、营养心肌等治疗后恢复窦性心律;17例不完全性束支传导阻滞;5例完全性左束支传导阻滞.1例术后10个月出现二度Ⅱ型房室传导阻滞,治疗后恢复至二度Ⅰ型房室传导阻滞.1例术后8d出现脑出血,开颅发现脑血管畸形,外科处理后治愈.术后患者左心室舒张末内径、心胸比例较术前改善.结论 经皮导管室间隔缺损介入封堵术具有创伤小、并发症少、无需体外循环、成功率高等特点,值得推广,但应规范选择患者和长期随访.     

国产封堵器介入治疗先天性心脏病的临床分析

目的探讨国产封堵器治疗先天性心脏病（CHD）的临床疗效及安全性。方法对43例CHD患者进行介入封堵治疗,并对结果进行分析。结果 43例患者中,封堵成功42例,成功率97.7%。1例动脉导管未闭患者因其未闭动脉导管较大伴重度肺动脉高压,未行封堵术;1例室间隔缺损患者术后半小时出现完全性房室传导阻滞,经置入临时起搏器于术后1 d恢复正常。结论国产封堵器治疗CHD疗效好,成功率高,价格低廉,严重并发症少。     

经导管封堵小儿室间隔缺损围术期心律失常的处理

目的探讨经导管室间隔缺损封堵术围术期出现的心律失常的处理方法.方法对182例先天性室间隔缺损的患儿进行室间隔缺损封堵术,经心电监测、常规心电图检查和24 h动态心电图检查,对围术期出现心律失常的31例患儿根据病情进行不同的处理.结果本组患儿无死亡,3例术后出现三度房室传导阻滞的患儿安装了临时起搏器,2例恢复窦性心律,1例转外科手术,外科术后恢复窦性心律.1例术中出现三度房室传导阻滞的患儿转心外科手术.左束支传导阻滞及二度房室传导阻滞的病例均行内科治疗并恢复,其他非严重心律失常病例给予内科对症治疗.结论经导管封堵室间隔缺损围术期心律失常的发生率相对较高,围术期的心电监测十分重要,术后要进行密切的随访观察.     

国产VSD封堵器治疗膜周部VSD 的研究

目的 探讨国产封堵器治疗膜周部室间隔缺损（PmVSD）的效果。方法 对武汉亚洲心脏病医院2012～2014年512例膜周部室间隔缺损介入封堵术进行回顾性分析。结果 介入治疗成功率93.16%,35例治疗失败。15例因新出现主动脉瓣关闭不全,10例出现中度及以上三尖瓣返流,收回封堵器,中止手术。另10例治疗失败为其他原因（包括：室间隔缺损较大,封堵器展开后腰征不满意或存在较大残余分流;建立轨道失败;导丝无法通过主动脉瓣行左室造影;术中出现高度房室传导阻滞;术中导丝激惹左心室反复出现心跳骤停终止手术;麻醉失败;穿刺失败）。封堵术后出现88例并发症,包括：2例出现机械性溶血;18例术后3个月仍存在1～2 mm残余分流（3.52%）;16例新出现三尖瓣轻度返流（3.13%）;52例术后出现心律失常（10.16%）;2例外科取出。无死亡、封堵器脱落、心脏压塞及心肌梗死病例。结论 经皮介入封堵膜周部室间隔缺损术具有一定风险,术前严格掌握适应证,术中选择合适的封堵器,出现并发症及时治疗和处理具有重要意义。     

经胸超声心动图和χ线透视下行膜部室间隔缺损封堵术

目的:探讨Am p latzer封堵器和国产封堵器的临床疗效以及经胸超声心动图和χ线透视下行膜部室间隔缺损(V SD)封堵术的安全性和有效性。方法:在经胸超声心动图和χ线指导下,对15例膜部(膜周)室缺患者行室缺封堵术,术后1 d,1月,3月,6月随访心电图和超声心动图检查。结果:左室造影测量室缺的大小为3~11 mm,经胸超声心动图测量V SD大小为3~10 mm,封堵器的大小为6~14 mm。15例患儿手术成功,其中8例选择Am p latzer封堵器,7例选择国产封堵器,二者在手术时间,手术即刻和随访的成功率无显著性差异(P>0.05),二组均无严重并发症发生。患儿住院时间为5~7 d,术后复查超声心动图未见主动脉瓣,三尖瓣的关闭不全,无残余分流,心电图无房室传导阻滞。结论:(1)Am p latzer封堵器和国产封堵器性能相同;(2)膜部室间隔缺损封堵术安全,有效。     

室间隔缺损介入治疗并发症及防治对策

对50例室间隔缺损(VSD)患者行介入封堵术治疗后的并发症进行回顾性分析,结果术中封堵器脱落、Ⅲ°房室传导阻滞各1例;术后左前分支传导阻滞、主动脉轻度关闭不全、少量残余分流各2例,封堵器脱落、溶血各1例;3个月后仅2例主动脉关闭不全.认为术前依靠超声心动图严格筛选适应证,术中选择适当封堵器,术后严密随访是成功行VSD介入治疗、减少严重并发症的关键.     

国产封堵器治疗先天性膜周部室间隔缺损的疗效评估

目的 评价应用国产封堵器治疗先天性膜周部室间隔缺损(pmVSD)的近期疗效和安全性.方法 选择2001年12月至2008年12月在上海长海医院心内科使用国产封堵器治疗的pmVSD患者604例.所有患者术后1周每天观察临床症状并行12导联心电图检查,术后3～7 d复查经胸超声心动图(TTE)和X线胸片.结果 604例患者中封堵成功576例,共置入封堵器583枚,放弃封堵28例,手术成功率95.4%.无感染性心内膜炎、血栓栓塞、猝死等并发症发生.81例患者术后出现不同类型的传导阻滞,其中右束支传导阻滞56例,左束支传导阻滞14例.31例患者在术后出现一过性的加速性室性自主心律.完全性房室传导阻滞(cAVB)11例,9例在3周内恢复,2例安置永久性心脏起搏器,其中1例术前有一过性cAVB,另1例为同时封堵房间隔缺损并室间隔缺损的患者.术后即刻,69例(12.0%)有微量-少量残余分流,术后7 d,31例分流完全消失,仍有38例(6.6%)存在微量-少量残余分流.术后主动脉瓣反流加重5例,2例由术前的微量加重到术后少量反流,3例由少量加重到中量;术后出现三尖瓣微-少量反流32例,中量反流3例.5例机械性溶血,其中1例持续5 d无好转,经导管取出封堵器,其余4例均在术后3～14 d恢复正常.1例术后出现股动脉假性动脉瘤,经加压包扎后消失.封堵器脱落1例,经导管取出,并成功行封堵治疗.封堵器移位1例,在原位置入另一封堵器.结论 使用国产封堵器治疗室间隔缺损成功率高,并发症少,是一种安全有效的治疗方法.     

自制封堵器闭合膜部室间隔缺损196例疗效评价

目的评价应用自制双盘形室间隔缺损封堵器闭合膜周部室间隔缺损的可行性和临床疗效.方法196例先心病膜周部室间隔缺损患者,男88例,女108例,年龄2～56岁,平均17.17±12.00岁.术前超声测量室间隔缺损直径3～15mm,平均(4.94±2.23)mm.应用7F～10F输送鞘管从右心系统送入双盘形封堵器.封堵后15min重复左心室造影和经胸心脏超声波检查,观察封堵的即刻效果.术后连续心电监护5天.出院前、术后1月、6月和1年定期复查心电图和心脏超声.结果196例中,191例患者封堵成功,成功率97.4%.左心室造影测量室间隔缺损直径3～17mm,平均4.76±2.96mm.所用封堵器直径为4～20mm,平均6.68±2.76mm.未成功的5例中,3例因导管未能通过室间隔缺损处,2例因封堵器放置后影响主动脉瓣关闭,而放弃封堵治疗.180例患者术后15min重复左心室造影和经胸心脏超声检查显示无残余分流,11例示少量残余分流,1月后复查经胸心脏超声,8例残余分流消失,其余3例仍存在微量残余分流.术中并发短暂的左、右束支传导阻滞分别为5例和12例,2例并发-过性完全性房室传导阻滞.封堵器放置后出现完全性右束支传导阻滞2例,随访期间未恢复.术后心电监护示非阵发性室性心动过速4例,1周后恢复.封堵器放置后脱落到左肺下动脉1例,经圈套器取出,并继续完成封堵治疗.合并房间隔缺损4例、动脉导管未闭2例,同期成功封堵.X线透视时间5～60min,平均13.17±7.68min,操作时间39～160min,平均59.48±18.18min.随访1个月～2年,无感染性心内膜炎、血栓栓塞和溶血等并发症.结论应用自制双盘形封堵器经导管闭合膜部室间隔缺损操作简便,疗效可靠,使用安全.     

Perimembranous ventricular septal defect with aneurysm: two options for transcatheter closure

We present our experience with 2 options for device closure of perimembranous ventricular septal defect with aneurysm. Thirty-four patients with perimembranous ventricular septal defect with aneurysm, aged from 14 to 42 years, underwent transcatheter closure with modified double-disk occluders. A sheath was used to deliver the occluder after establishment of a stable "arteriovenous loop" under fluoroscopy. Electrocardiography and transthoracic echocardiography were used for follow-up. All but 1 patient experienced successful transcatheter closure of perimembranous ventricular septal defect with aneurysm, when occluders were used in 2 different positions. There were 19 patients whose perimembranous ventricular septal defects were closed at the inlet of the aneurysm and 15 patients whose defects were closed at the outlet. Eight patients had a residual shunt immediately after the procedure, which disappeared during follow-up. One patient developed minor aortic regurgitation. Four patients who manifested different types of conductive block were all in the group that underwent closure at the inlet of the aneurysm. No other complications were observed during follow-up.We infer that perimembranous ventricular septal defect with aneurysm can be successfully closed with modified double-disk occluders. Each of the 2 options that we have presented for transcatheter closure of perimembranous ventricular septal defect with aneurysm has its advantages and disadvantages. Ultimately, the configuration of the lesion should decide the type and position of the device.     

应用国产封堵器治疗儿童大型动脉导管未闭的疗效研究

目的:评价应用国产封堵器经导管治疗儿童大型动脉导管未闭的安全性及有效性。方法:12岁以下大型动脉导管未闭患儿66例,应用国产封堵器经导管进行介入治疗,于术后1、3、6月及每年进行超声心动图等随访,观察有无残余分流及主动脉狭窄等,评估该方法的效果及安全有效性。结果:技术成功率97%。应用目前最大封堵器失败转外科手术1例,由于重度肺动脉高压,试封堵后肺动脉压力无明显改善而放弃治疗1例。手术即刻残余分流率为23%,随访观察1月后为3%,6月后所有64例患儿均无残余分流。结论:国产封堵器经导管治疗儿童大型动脉导管未闭安全可行。     

室间隔缺损介入治疗五年临床随访分析

目的 总结分析室间隔缺损(VSD)介入治疗后的随访结果,重点分析其并发症发生情况.方法 2002年11月至2007年11月,共有445例膜周部VSD患者接受了介入封堵术,其中男性203例,女性242例,年龄2.5～58(14.2±6.8)岁.所有患者均经股静脉途径放置封堵器,采用的VSD封堵器包括进口偏心伞及国产对称伞.所有患者术后1、3、6、12个月(其后相隔1年)进行门诊随访,复查超声心动图、X线胸片、心电图.结果 共有417例患者封堵成功,总技术成功率93.7%(417/445),未发生与手术相关的死亡.至2008年2月,平均随访25.6个月(3个月～5年),严重并发症发生率为2.2%(10/445),其中包括三度房室传导阻滞安装永久起搏器2例、左束支传导阻滞伴左心室增大2例、中-大量主动脉瓣反流2例、中量三尖瓣反流2例、中量二尖瓣反流1例、溶血1例.术后5年有7例患者仍存在少量残余分流,总完全封堵率为98.3%(410/417).结论 VSD介入治疗总体上安全有效.应注意适应证的选择和术后严格随访,以减少严重并发症及晚期并发症的发生.     

膜周型室间隔缺损经皮导管介入封堵术中建立输送轨道的操作技巧

目的 介绍膜周型室间隔缺损（PmVSD）导管介入封堵术中建立轨道时的一种操作技巧.方法 选择117例PmVSD患儿实施经皮导管介入封堵术,术中应用导丝引导输送鞘管指向左心室心尖部的方式建立输送轨道,观察手术效果及并发症的发生率.结果 全部手术时间22～58 （33.36±8.50） min,X线透视时间（13.02±4.11） min.12岁以下儿童75例采用全麻下实施操作,余患者均采用5％利多卡因局麻下实施.所有病例手术均获得成功,但有25例因术中导丝穿过三尖瓣腱索而重新建立轨道;有16例发生一过性室性心律失常,1例出现窦性心动过缓、窦性停搏,恢复后继续实施操作并获得成功;有2例因封堵器型号不当而更换封堵器.有1例术后出现微量残余分流.术后未出现即刻主动脉瓣反流、新发的三尖瓣反流及溶血者.随访12个月中并未发生封堵器移位、迟发的传导阻滞、主动脉瓣关闭不全、感染性心内膜炎及溶血.结论 应用导丝引导输送鞘管指向左心室心尖部这一改良技术可提升PmVSD导管介入封堵术建立输送轨道时的安全性.     

Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results

With the development of interventional techniques and devices, transcatheter closure of perimembranous ventricular septal defect has been widely performed. However, there has been a lack of long-term follow-up results about postoperative ECG changes of PmVSD patients. We report our experience of early and late arrhythmias after transcatheter closure of PmVSD with a modified double-disk occluder (MDVO). We performed a retrospective review of 79 patients (47 males, 32 females) between September 2002 and May 2007 who underwent transcatheter closure of perimembranous ventricular septal defect. Symmetric and asymmetric PmVSD occluders were used. The diameter of the evaluated defects ranged from 3 to 12?mm, as measured by TTE and 3 to 15?mm by left ventriculography. Most cases of PmVSD were treated successfully with a single procedure, resulting in a successful closure rate of 97% (77/79 patients). There was no death in any of the patients. After the operation, 79 patients were followed-up for a range of 10–76?months (35.3?±?17.4?months). In this series, 11 cases of incomplete right bundle branch block and five cases of complete right bundle branch block occurred during the early period after operation. During long-term follow-up, these issues declined in prevalence to five and four cases, respectively. Moreover, reversible third-degree AVB occurred during closure or after the procedure, and two of the three patients with reversible AVB received a temporary heart pacemaker implantation. These patients recovered 1?h, 6?days, and 9?days later, respectively. During 10–76?months of follow-up, no complications occurred in any of the patients, including residual shunt, severe aortic valve, or tricuspid valve regurgitation. Device closure of perimembranous ventricular septal defects with a modified double-disk occluder (MDVO) resulted in excellent closure rates and acceptably low arrhythmia rates.     

Trans-esophageal echocardiography guided closure of ventricular septal defect with 2 occluders from different incisions simultaneously: A case report

Introduction:Ventricular septal defect (VSD) accounts for up to 40% of all congenital cardiac malformations. Transthoracic closure of VSDs has been well described in literature. In the current report, we described a procedure to successfully close a VSD with 2 occluders from different incisions simultaneously under the guidance of trans-esophageal echocardiography (TEE), to save the patient from undergoing another surgery.Patient concerns:A 52-year-old man was referred to our clinic for repeating palpitations for 6 months without chest pain and polypnea after activity.Diagnosis:The diagnosis of VSD was established due to the findings of a juxtatricuspid VSD with a left-to-right shunt at ventricular level and mild mitral regurgitation by TTE.Interventions:A transcatheter VSD closure was firstly performed but failed to repair the VSD. After the failure of transcatheter VSD closure, the patient received transthoracic closure of VSD operated by a cardiac surgeon. The VSD was closed with 2 occluders from different incisions (median thoracic skin incision and subxiphoid incision) simultaneously under the TEE guidance.Outcomes:The patient was extubated in intensive care unit and was discharged 4 days after the operation. During the follow up, there were no significant clinical nor laboratory side-effects of the procedure found as compared to the patient''s condition before the procedure.Conclusion:VSD can be closed with 2 occluders from different incisions simultaneously under the TEE guidance to save the patient from undergoing repeated surgeries. Meanwhile, TEE plays a significant role in cardiac surgery.     

Percutaneous ventricular septal defect closure with amplatzer devices resulting in severe tricuspid regurgitation

While percutaneous intervention is an alternative for patients who are not surgical candidates, the rate of morbidity and mortality is comparable to open repair. Appending the reported complications associated with percutaneous intervention (device mal‐positioning, dislodgement, and entrapment in the sub‐valvular apparatus), we report mechanical damage to the tricuspid valve (TV). Percutaneous closure with an Amplatzer septal occluder device was attempted on three patients who developed a ventricular septal defects (VSD) after myocardial infarction. In all three cases, damage to the tricuspid leaflet was noted post‐procedure. The accompanying severe tricuspid regurgitation led to right ventricular failure, even in the patients where the VSD was considered successfully occluded. Despite successful deployment of the Amplatzer device, complications with catheter manipulation may still arise. Damage to the TV can occur during percutaneous VSD closure with Amplatzer device. Periprocedure TEE monitoring can detect damage to the tricuspid leaflets. © 2013 Wiley Periodicals, Inc.     

Percutaneous transcatheter ventricular septal defect closure in adults with Amplatzer septal occluders

BACKGROUND: The interest in transcatheter ventricular septal defect (VSD) closure is continuously growing. Therefore, we report our experience in perimembranous (Pm) and postinfarction (Pi) VSD closure. METHODS: All patients, older than 16 years, were selected from a data base, in which Pm and Pi VSDs were registered.The patients' files were reviewed until the most recent follow-up date. RESULTS: Nine (7 male, 37.4 +/- 12.8 y) and 8 (6 male, 76.3 +/- 6.2 y) patients underwent a Pm (group A) and Pi VSD (group B) closure, respectively. One female patient was treated for a posttraumatic VSD (26 y). In group A, 7 patients were closed with the Amplatzer perimembranous VSD occluder, one with the muscular VSD occluder, and one patient with the atrial septal defect occluder. All patients in group B were treated with the muscular VSD occluder. In the post-traumatic VSD an Amplatzer patent foramen ovale occluder was used. Device implantation was feasible in all, except in two patients with extremely large VSDs (one Pm and one PiVSD). Total transcatheter closure or small residual leakage was achieved in 7/8 patients in group A, but one patient needed surgical VSD repair because of massive haemolysis, another patient died 9 months later. A small or moderate shunt was present immediately after the procedure in all patients of group B. No device-related complications were reported, but all, except one patient, died within 2 weeks after the procedure because of an extremely high co-morbidity (logistic Euroscore 70 +/- 25%).Total closure was achieved in the post-traumatic VSD. CONCLUSION: Transcatheter closure of Pm and Pi VSD with Amplatzer septal occluders in adults is feasible and safe, but the post-procedural prognosis totally depends on the aetiology of the VSD and its co-morbidity.     

小腰大边封堵器和对称封堵器经导管介入治疗巨大囊袋形室间隔缺损的对比研究

目的探讨巨大囊袋形室间隔缺损采用小腰大边封堵器和对称封堵器经导管介入治疗的适应证。方法2004年8月至2008年12月在我科行室间隔缺损封堵术的患者,超声和左心室造影检查为巨大囊袋形室间隔缺损者共计132例,其中男59例,女73例;年龄18.2±10.6（2～49）岁;缺损口左室面直径13.8±4.5（10～24）mm。按选用封堵器的类型分为小腰大边封堵器组和对称封堵器组。术后随访心脏彩色多普勒超声和ECG变化。结果小腰大边封堵器组58例,其中男23例,女35例,年龄12.8±10.9（2～32）岁,植入封堵器腰部直径6～16mm;对称封堵器组74例,其中男36例,女38例,年龄15.4±10.8（2～49）岁,植入封堵器腰部直径6～24mm。小腰大边封堵器组和对称封堵器组术后3～6个月残余分流的发生率（3.4%比4.1%）,新出现的三尖瓣反流（5.2%比5.4%）、主动脉瓣反流（3.4%比6.8%）和右室流出道狭窄（3.4%比5.4%）差异均无统计学意义（P〉0.05）。两组术后ECG变化差异无统计学意义（P〉0.05）。结论小腰大边封堵器和对称封堵器经导管介入治疗巨大囊袋形室间隔缺损效果满意,但需要注意两种封堵器选择的不同适应证,以保证最好的封堵治疗效果。