Spontaneous closure of perimembranous ventricular septal defect after school age

Background: The number of studies of long‐term follow up to adolescence is very low on spontaneous closure (SC) of perimembranous ventricular septal defects (P‐VSD) in children not undergoing surgical closure because of small left‐to‐right shunting. Methods: Seventy patients with a P‐VSD with pulmonary‐to‐systemic flow ratio (Qp/Qs) < 1.7 underwent cardiac catheterization at the age of 2–10 years (mean, 5.1 years). Excluding 22 patients who dropped out by 15 years, 48 were selected. Qp/Qs ranged from 1.00 to 1.68 (mean, 1.17). The average follow‐up period of 37 patients excluding the SC patients was 17.8 years. They were classified according to Qp/Qs into three groups: group I, 1.4 ≤ Qp/Qs < 1.7; group II, 1.2 ≤ Qp/Qs < 1.4; and group III, 1.0 ≤ Qp/Qs < 1.2. Results: SC occurred in 11 patients (23%). SC rates in group I and II were lower than those in group III (I, 0/8 0%; II, 1/10 10%; III, 10/30 33%). In 23 patients (48%), an aneurysm of the ventricular membranous septum (AVMS) was detected, but no significant relationship was found between the presence of AVMS and SC rate. Conclusions: SC occurred in 23% of patients with a P‐VSD of Qp/Qs < 1.7 up to adolescence. But a P‐VSD of Qp/Qs ≥ 1.2 showed no tendency to close spontaneously. The factor most influencing SC of P‐VSD after school age seemed to be the shunt ratio.     

膜周部室间隔缺损介入封堵和外科修补后常见并发症的对比分析

目的 分析介入封堵和外科修补治疗儿童膜周型室间隔缺损(pmVSD)后常见并发症情况,为临床上个体化优选治疗方案提供依据。方法 回顾性分析2014年6月至2020年4月期间住院治疗的pmVSD患儿的临床资料。根据最终采取的手术方式分为介入组和修补组,分析比较两组患儿术后常见并发症情况及随访资料。结果 最终入选499例患儿。介入组284例,男130例、女154例,中位年龄42.0(33.0～56.0)月;修补组215例,男100例、女115例,中位年龄40.0(30.0～60.0)月。两组之间术后1周内残余分流,主动脉瓣、二尖瓣和三尖瓣反流发生率的差异无统计学意义(P>0.05)。修补组术后1周内新发心律失常、完全性及不完全性右束支传导阻滞的发生率均高于介入组,差异有统计学意义(P<0.05)。至随访终点时间,两组患儿的残余分流、瓣膜反流及传导阻滞情况均明显改善,两组间差异均无统计学意义(P>0.05)。结论 介入封堵和外科修补治疗儿童膜周部室间隔缺损同样有效,且介入治疗创伤小、并发症少,是一个不错的选择。     

Spontaneous closure of muscular trabecular ventricular septal defect: comparison of defect positions

Aim: To evaluate the timing and frequency of spontaneous closure of the muscular trabecular ventricular septal defect (VSD). Methods: We performed a historical cohort study for which 150 patients <3 months of age (median age, 9 days) diagnosed as having a muscular trabecular VSD were selected. Median age at latest follow‐up was 2.8 years. Another 32 patients diagnosed after 3 months of age were also reviewed. Using colour Doppler, defects were classified into three groups: anterior, apical and midventricular. Results: Spontaneous closure occurred in 126 patients (84%): anterior, 36 of 47 (83%); apical, 26 of 31 (84%); and midventricular, 64 of 72 (89%). Multivariate analyses showed a lower frequency of spontaneous closure for patients of age of ≥20 days at initial echocardiography [hazard ratio 0.60, 95% confidence interval (CI) 0.39–0.89] and for anterior and apical muscular trabecular VSD (hazard ratio 0.66, 95% CI 0.47–0.95). The prevalence of the midventricular muscular trabecular VSD was significantly lower in patients ≥3 months of age at initial echocardiography than in those <3 months (p = 0.010). Conclusion: We infer that midventricular muscular trabecular VSD tends to close spontaneously earlier and more frequently than either anterior or apical muscular trabecular VSD.     

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??Abstract??Objective To evaluate the clinical effect of transcatheter closure for ventricular septal defect in infants and young children. Methods Clinical data from 184 children under 3 years old who underwent the transcatheter VSD closure from Jan. 2011 to Dec. 2012 were analyzed. Results Procedure was successful in 176 cases ??95.7%??. No death occurred?? residual shunt in 13 cases?? tricuspid inflow accelerated in 2 cases?? late-onset complete atriovenous block in one case ??6 months after procedure??. All cases had no vascular complications. Conclusion Transcatheter closures for ventricular septal defects are effective in small children. Long-term follow-up is needed to evaluate the safety of this operation. The keys to the success of operation are the proper indications,suitable apparatus,skillful vascular punction and good anaesthetic management.     

Intrauterine closure of membranous ventricular septal defects: Mechanism of closure in two autopsy specimens

Summary Anatomic evidence of intrauterine closure of ventricular septal defects (VSDs) has been reported rarely. Between 1985 and 1990, 112 autopsies were performed at the Mayo Clinic on third trimester stillborns and infants who died during the first week of life. There were 21 (19%) cases of congenital heart disease. VSD was found in 12 (11%) cases: in eight (7%) as a part of a more complex heart defect and in four (4%) as an isolated lesion. Two cases with membranous VSDs with tricuspid valve tissue partially occluding the ventricular septal defect were found. A 2280-g female infant (case 1) with trisomy 18 died at 4 days of age. Autopsy revealed bilateral superior venae cavae, a large atrial septal defect, cor triatriatum, an atypical tricuspid valve with large septal leaflet partially obstructing a large membranous VSD, a hypoplastic right ventricle, and severe pulmonic stenosis. A 2610-g female infant (case 2), born with congenital heart block died at 4 days of age. Autopsy revealed cor triatriatum dexter obstructing the tricuspid orifice, a large membranous VSD partially obstructed by the septal leaflet of the tricuspid valve, four small muscular VSDs, and pulmonic stenosis. These cases suggest that closure of membranous VSDs may gegin in utero and the mechanism of closure is similar to that reported postnatally.     

国产双盘状封堵器治疗儿童膜周部室间隔缺损效果及随访研究

目的 探讨国产双盘状封堵器治疗儿童膜周部室间隔缺损（VSD）的效果及其随访。方法 75例膜周部VSD患儿，年龄3~14岁,平均（8.5±3.6）岁，VSD直径为3.0~14.0 mm，平均（6.5±3.6）mm，采用经导管植入国产双盘状封堵器，门诊随访，进行心脏听诊、超声心动图检查有无残余分流及封堵器位置。结果 ①74例封堵器植入成功，技术成功率98.7%，1例导管未能通过室间隔缺孔；②术后即刻左心室造影示：65例（87.8%，65/74）无残余分流，9例（12.2%，9/74）存在微量至少量残余分流，超声心动图示：68例（91.9%，68/74）无残余分流、6例（8.1%，6/74）存在微量至少量残余分流；2例封堵术后3 d发生Ⅲ度房室传导阻滞，应用泼尼松及营养心肌药物治疗4~10 d后消失。1例封堵术后24 h发生溶血，经过7 d内科保守治疗治愈；③术后1个月共随访73例患儿，超声心动图示：71例（97.3%，71/73）无残余分流、2例（2.7%，2/73）存在微量至少量残余分流；④术后3个月、6个月、1年、2年和3年，随访到的病例分别为70、68、21、15和12例，存在微量至少量残余分流的2例分别于3和6个月内残余分流消失。结论 经导管植入国产双盘状封堵器治疗儿童膜周部VSD是一种安全有效的微创介入治疗方法，操作简便，成功率高，近期和远期疗效可靠。     

Increasing incidence of ventricular septal defects caused by improved detection rate

Meberg A, Otterstad JE, Frøland G, Sørland S, Nitter-Hauge S. Increasing incidence of ventricular septal defects caused by improved detection rate. Acta Pzdiatr 1994;83:653–7. Stockholm. ISSN 0803–5253
In a population-based study in childrcn born alive during the 10-year period from 1982 to 1991 ( n = 22 810), ventricular septal defects (VSDs) were diagnosed in 127 cases, an incidence of 5.6 per 1000. The incidence was significantly higher in the cohort of children born during the 6-year period from 1986 to 1991 than among those born in the preceding 4-year period, 1982–1985 (6.5 and 4.0 per 1000 respectively; p < 0.05). The increase was caused entirely by an increased detection rate of small defects in the muscular part of the interventricular septum after introducing echocardiography as a standard method for investigating suspect congenital heart defects in the neonatal period. This also explained entirely an increase in the total incidence of congenital hcart defects to 10.6 per 1000 in the last period from 8.4 per 1000 in the first, although this increase was not significant ( p > 0.05). Morc children born in 1986–1991 had spontaneous closure of their VSDs (75.5%) than those born in 1982–1985 (51.5%) ( p<0.05 ). In 69.3% of patients the VSDs closed during the first year of life. For the cohort born in 1986–1991, 84.6% of the defects located in the muscular part of the septum closed spontaneously. Small defects in the muscular part of the interventricular septum with spontaneous closure in early life may represent the tail of a normal developmental process, and not defects in the sense of malformations.     

小儿经胸微创室间隔缺损封堵术的临床经验

目的 总结2个儿童心脏中心食道超声经胸微创室间隔缺损(ventricular septal defect,VSD)封堵术的临床经验.方法 回顾性分析2008年7月至2011年7月浙江大学医学院附属儿童医院及宁波市妇女儿童医院2个儿童心脏中心行食道超声经胸微创VSD封堵术142例的临床资料.其中,膜周部VSD 95例,嵴内型VSD 37例,肌部VSD 10例.VSD直径:经胸超声下3.0～8.5 mm,平均(4.7±0.8)mm;食道超声下2.5～8.0 mm,平均(4.3±1.0) mm.结果 142例中140例当时封堵成功(97.2％),其中1例(0.7％)术后第5天出现Ⅲ°房室传导阻滞、阿斯综合征,术中转体外循环(CPB)下封堵器取出+VSD修补,术后逐渐恢复窦性心律;1例(0.7％)嵴内型肺动脉瓣下VSD当时封堵成功,术后5h出现封堵器脱落嵌于左肺动脉,急诊CPB下主肺动脉切开封堵器取出+VSD修补.选用膜周部对称伞85例,偏心伞47例,肌部伞8例.3例(2.1％)新出现微量三尖瓣反流.9例(6.4％)术后出现不完全性右束支传导阻滞,1例(0.7％)术后出现Ⅱ°Ⅰ型房室传导阻滞伴心室内差异传导,经过甲基强的松龙静滴后转为窦性心动过速,偶发房早.术后在监护室当天拔气管插管,第2天转回普通病房.平均(7.1±2.2)d出院.术后133例(95.0％)随访至今,分别在术后1个月、3个月及每年复查心电图、胸片及心脏超声,最长已36个月.无死亡,未见伞片移位、未见残余分流及瓣膜反流加重,无严重心律失常等并发症.结论 经胸微创室间隔缺损封堵术是一种微创手术治疗方法,操作简单,安全性高,具有推广应用价值.     

三个月以内婴儿室间隔缺损的外科治疗

目的　总结手术矫治 3个月以内婴儿室间隔缺损的效果。方法　 1999年 6月～ 2 0 0 1年 11月手术治疗 2 0例先天性心脏病室间隔缺损伴肺动脉高压婴儿 ,其中男 12例 ,女 8例。年龄 34～ 10 4d ,平均 (74.6 5± 9.70 )d。体重 3.35～ 7.0 0kg ,平均 (4 .93± 0 .94)kg。室间隔缺损均为单发 ,其中膜周型 16例 ,肺动脉瓣下 4例。 2例合并动脉导管未闭 (PDA) ,1例合并房间隔缺损 (ASD)、PDA及主动脉缩窄 (CoA) ,1例合并ASD和右冠状动脉 右室瘘。所有患儿均在全麻低温体外循环下行Ⅰ期矫治术。结果　术后早期 (30d内 )死亡 1例 (病死率 5 .0 % )。发生并发症者 10例 ,发生率5 0 .0 %。肺不张 4例 ,低心排 2例 ,心律失常 2例 ,肺炎 2例 ,胸腔积液 1例 ,渗漏综合征 1例 ,经治疗后痊愈出院。结论　反复肺炎和肺动脉高压的室间隔缺损婴儿应尽早手术根治。术后应注重呼吸道的管理和出入量的调整     

室间隔缺损介入治疗前后心电图变化的探讨

目的探讨经导管室间隔缺损封堵术后出现的心电图变化。方法对263例室间隔缺损的患儿进行室间隔缺损封堵术,经常规12导联心电图检查对出现心电图变化者进行分析。结果出现异常心电图变化有77例(心律失常57例),其中围手术期出现变化的有65例[交界性22例,完全性右束支传导阻滞(CRBBB)7例,CRBBB+交界速5例,CRBBB+左前分支传导阻滞(LAH)3例,完全性左束支传导阻滞(CLBBB)2例,CRBBB+早搏2例,CRBBB+Ⅰ度房室传导阻滞1例,LAH 4例,电轴左偏19例;术后1个月出现变化4例(其中CRBBB3例,电轴左偏1例);术后3个月出现变化5例(其中交界性1例,CRBBB 3例,CLBBB 1例);术后6个月出现变化3例(其中交界性2例,Ⅲ度房室传导阻滞1例)。结论经导管封堵室间隔缺损,对心脏电生理活动有较大影响,从而可诱发各种心律失常。围手术期心律失常的发生率相对较高,术后近期、中期心律失常的发生率不容忽视,术后长期密切随访观察必不可少。     

Parental perception of small ventricular septal defects in childhood

OBJECTIVE: The main aim of this study was to determine the understanding and perception of parents following the diagnosis of a minor cardiac abnormality, namely a small ventricular septal defect, in the child. Other aims included discovering the reasons behind these perceptions and whether they affected the parents' management of their child and his/her cardiac problem. METHODS: Fifty-six infants and children from two tertiary centres and the private practices of the participating cardiologists were enrolled over a 5-month period. Questionnaires were prepared and distributed to all their parents. RESULTS: Complete data was obtained from 40 parents. Close to 80% of the parents perceived the small ventricular septal defect as a minor problem and most understood the nature of the defect. However, when asked about precautions for their child, only two-thirds recalled the need for antibiotic prophylaxis. Most parents experienced distress and anxiety when told initially of the diagnosis but none reportedly restricted their child's physical activity. CONCLUSIONS: Most parents have a clear understanding and perception of their child's small ventricular septal defect. There is a need for further improvement to facilitate parental understanding, especially with regard to the need for antibiotic prophylaxis.     

避免膜周部室间隔缺损经导管封堵术发生心律失常的临床探讨

目的 通过分析膜周部室间隔缺损(perimenbranous ventricular septal defects,PMVSD)封堵治疗术前、术中和术后发生心律失常的情况,探讨介入治疗发生心律失常的相关影响因素,以期降低术后心律失常的发生率.方法 分析2005年11月至2008年1月行封堵治疗的65例先心病室间隔缺损患者封堵术前、术中和术后心律失常的发生率、类型及其可能的相关因素.结果 65例室间隔缺损患者术前有7例心律失常,表现为不完全或完全性右束支阻滞(IRBBB或CRBBB)、左前分支阻滞(LAH)等.术中可见多种类型的心律失常,其中在导丝和输送鞘通过室间隔时多出现房室传导阻滞(AVB)、交界性逸博、室性早博、室内差异性传导、室性心动过速等.术后心律失常发生率为12.3%(8/65),分别为l度房室传导阻滞2例,ILBBB 1例,LAH 1例,IRBBB 3例,室性早博1例,与术中的心律失常情况有一定的关系.术前已存在的7例心律失常经封堵治疗后,有1例Ⅰ度房室传导阻滞合并左前分支阻滞,其余无变化,随访未出现新的心律失常.对封堵术后心律失常影响因素进行单因素分析,提示与封堵器大小、缺损距三尖瓣隔瓣、主动脉右冠瓣距离、术中动一静脉轨道建立时问、术中是否出现Ⅱ度或Ⅲ度房室传导阻滞密切相关.结论 临床选择VSD封堵器直径≤8 cm、缺损距主动脉右冠瓣和三尖瓣隔瓣距离≥3 cm的患者进行封堵治疗,可减少术后心律失常的发生率;术中建立轨道时间长短及有无发生Ⅱ度AVB和(或)Ⅲ度AVB,也是影响术后发生心律失常的重要因素.临床在把握介入治疗适应证的同时,重视PMVSD与传导系统的空间位置,避免选择过大的封堵器用于治疗,缩短手术时间,注意手术过程心电变化的提示作用,是降低PMVSD封堵术后发生严重心律失常的有效措施.     

室间隔缺损经导管封堵术后并发症的发生机制及治疗

室间隔缺损是最常见的先天性心脏畸形。经导管封堵术在膜周部室间隔缺损的治疗中发挥着越来越重要的作用。随着介入治疗的病例数不断增加，相关即刻及远期的并发症正逐渐被重视。该文对室间隔缺损经导管封堵术后并发症的发生情况、发生机制及治疗进行综述，重点关注心脏传导阻滞发生情况。     

Echocardiographic evaluation of the development of aortic valve prolapse in supracristal ventricular septal defect

The development and timing of aortic weve prolapse (AoVP) and aortic regugitation (AR) was studied by two limensional echocardiography in 99 consecutive patients with supracristal ventricular septal defect (VSD). Thirty patients (30%) had aortic valve prolapse (VSD+AoVP group), and 31 patients (31%) had AoVP with AR (VSD+AoVP+AR group). In the VSD+AoVP group, AoVP was detected first by echocardiography at the age of 6.8±4.2 years (mea±SD). In the VSD+AoVP+AR group, the interval from detection of AoVP to the appearance of Al was 3.4±2.0 years. The configuration of the prolapsed aortic valve was echocardiographically classified into two types: teardrop type (small) prolapse and box type (large) prolapse. The frequency of tear-drop tyrolapse was not significantly different between VSD+AoVP and VSD+AoVP-AR groups (43% versus 32%, respectively), indicating that even minor AoVP can result, AR. Four infants (4%) had AoVP at the ages of 1, 5, 7, and 11 months, respectively. All infants had tear-drop type prolapse. Two infants developed AR by colour flow mapping at the ages of 3 and 11 months, and the interval from prolapse to AR was only 2 and 4 months, respectively.Conclusion Aortic valce, involement can develop under the age of 1 year in supracristal VSD. Regular evaluation by two-dimensional echocardiography with colour flow mapping is important in the followup of children with supracristal VSD.     

儿童室间隔缺损自然闭合影响因素探讨

目的探讨影响儿童室间隔缺损(VSD)自然闭合的因素。方法于1993-01—2006-01采用彩色二维多普勒超声心动图仪或实时三维心脏彩色多普勒超声仪对潍坊市人民医院儿科诊治的372例单纯VSD患儿进行多切面观察,充分显示VSD部位、游离缘,测量缺损大小、穿隔血流宽度、肺动脉收缩压(Pp)和双室内径等,并查X线胸片及体检。每3～6个月随访1次,最长随访时间8年。结果75例VSD自然闭合,确诊年龄(11.7±5.1)个月,闭合年龄(26.2±11.6)个月。6个月至3岁组闭合率最高(72.0%),后依次为<6个月组(13.3%),～6岁组(12.1%),～7岁组(2.7%);闭合组62例收缩期杂音消失,13例变为Ⅰ或Ⅱ级局限的收缩期杂音;闭合组均为小中型VSD,大型VSD无一例闭合,两组差异有显著性(P<0.01)。闭合组和未闭合组VSD直径分别为(8.7±3.6)mm、(13.7±4.8)mm,差异有统计学意义(P<0.01);单发VSD闭合率高于多发VSD(P<0.01);膜周部VSD闭合62例,肌部VSD闭合13例,干下型无闭合病例,差异有显著性意义(P<0.01)。肌部VSD闭合率高于膜周部(P<0.01);超声心动图(UCG)显示VSD游离缘不规整回声弱者闭合率显著高于游离缘规整回声强者(P<0.01);闭合组和未闭合组Pp分别为(27.2±11.7)mmHg(1mmHg=0.133kPa)、(39.2±12.6)mmHg,差异有统计学意义。Pp越高,自然闭合率越低,>50mmHg无闭合病例;闭合组左室舒张末径(LVEDD)、右室舒张末径(RVEDD)、心胸比率(C/T值)显著低于未闭合组(P均<0.01)。结论VSD患儿年龄,缺损大小、类型、数目、形态,Pp,心室大小是影响VSD自然闭合的因素。VSD游离缘回声弱且不规整形态可作为缺损有自然闭合趋势的重要标志。Pp监测对判定漏诊的多发VSD有一定价值。     

Left ventricular end-systolic wall stress to volume relationship before and after surgical closure of ventricular septal defect

Summary Left ventricular function was examined angiographically in 64 patients with ventricular septal defect and 13 postoperative patients with a preoperatively large shunt (postoperative group). The unoperated 64 patients were divided into three groups; small (left-to-right shunt ratio <35%), moderate (35%–50%), and large (>50%). The control group consisted of 27 patients with Kawasaki disease. For assessing left ventricular function, left ventricular shape and the end-systolic wall stress to end-systolic volume index ratio, as well as left ventricular ejection fraction were examined. Left ventricular ejection fraction was higher in the small-shunt group (p<0.05) than in the control group, but normal in the other groups. Left ventricular end-diastolic shape was normal only in the small-shunt group and more spherical in the other groups. The large-shunt group alone manifested more spherical left ventricular end-systolic shape and lower end-systolic wall stress to end-systolic volume index (p<0.001). These findings suggest that the left ventricular dysfunction is present in patients with a left-to-right shunt larger than 50%, but this change was reversible in patients who underwent early repair of ventricular septal defect.     

儿童膜周部室间隔缺损介入治疗的临床评价

目的　评价经导管室间隔缺损封堵术介入治疗膜周部室间隔缺损 (VSD)的安全性及临床疗效。方法　 2 0 0 2年 11月～ 2 0 0 4年 7月 ,共 5 0例膜周部室间隔缺损的患儿接受了Amplatzer偏心状封堵器经导管介入治疗。男 2 6例 ,女 2 4例 ;平均年龄 (9 1± 4 8)岁 (2～ 17岁 )。其中 1例合并主动脉窦窦瘤 ,2例为外科修补术后残余漏 ,1例合并镜面右位心。经胸超声心动图 (transthoracicechocardiography ,TTE)提示 ,VSD的平均直径 (4 8± 0 9)mm (3～ 7mm )。封堵前右心导管提示 ,肺循环血流量 /体循环血流量 (Qp/Qs)比值平均为 1 32 (1 1～ 2 0 )。 4例中等量左向右分流 ,其余均为少量左向右分流。所有患儿在X线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个月进行超声心动图、心电图、X线胸片随访评价。结果　 4 7例患儿封堵器置入成功 ,技术成功率为 94 % ,无死亡病例。术后出现少量残余分流 2例 (<3mm) ,完全性左束支传导阻滞 1例 ,无其他严重并发症发生。所有患儿接受了平均 7个月的随访 (1～ 18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 ,1例残余分流于 6个月随访时消失。超声测量的左室舒张末径 (leftventricleend diastolicdimension     

改良切口经胸微创封堵术治疗膜周室间隔缺损

目的 探讨改良切口经胸微创室间隔缺损封堵术的可行性和安全性.方法 2011年5月至2015年5月,289例单纯膜周室间隔缺损患儿在我中心接受改良切口经胸室间隔缺损封堵术.该操作采用长约1～2 cm的微创切口,无需损伤胸骨,完全食道超声引导下完成室间隔缺损封堵.术后1、3、6个月定期随访.结果 289例患儿中,277例(95.8％)成功完成微创封堵;12例封堵失败,改行常规外科修补术.277例患儿均经改良微创切口入路,切口长度1～2cm,平均(1.53±0.46)cm.均未损伤胸骨,亦未放置引流管.术后早期均未出现心包积液.膜周室缺直径平均(5.30±2.88)mm.封堵器大小4～12mm,平均(6.70±3.10)mm,包括对称封堵器191例,偏心封堵器86例.12例(4.3％)患儿术中存在少量残余分流.9例(3.2％)术后发生不完全性右束支传导阻滞;1例患儿于术后4d出现完全性房室传导阻滞,经激素治疗5d后好转.所有患儿平均住院时间(3.2±0.8)d,随访期间,没有主动脉瓣反流、恶性心律失常、封堵器脱落等严重并发症发生.至随访结束仍有4例(1.4％)存在少量残余分流.结论 改良切口经胸壁微创封堵术,不损伤胸骨,可以有效治疗膜周室间隔缺损.但其长期疗效尚需进一步随访研究.     

膜周部室间隔缺损经导管封堵术后早期心律失常危险因素的探讨

目的心律失常是经导管封堵膜周部室间隔缺损术后的常见并发症,不仅影响术后心功能的恢复,而且直接关系到预后。分析18岁以内患者膜周部室间隔缺损经导管封堵术后早期心律失常及其危险因素,以期降低术后心律失常的发生率。方法2002年6月—2004年6月,89例膜周部室间隔缺损患者根据家长意愿接受了经导管应用Amplatzer装置及国产封堵器进行堵塞。80例应用AGA公司制造的Amlatzer膜周部室间隔缺损封堵器,9例应用国产封堵装置,术后定期行心脏超声及心电图检查。结果89例膜周部室间隔缺损封堵术均获成功。11例术后5d内发生了不同类型的传导阻滞,发生率为12%,分别为Ⅰ°房室传导阻滞1例,Ⅲ°房室传导阻滞1例,左前分支阻滞5例,不完全(部分)性右束支传导阻滞4例,完全性右束支传导阻滞3例,其中3例并发两种传导阻滞。分析本组心律失常的影响因素,发现:(1)室间隔缺损上缘距主动脉右冠瓣距离<3mm;(2)室间隔缺损直径≥8mm,封堵器直径≥10mm;(3)穿刺成功后动脉静脉(A-V)轨道建立时间≥60min及术中pH值<7·35与心律失常密切相关。结论心律失常是膜周部室间隔缺损封堵术后早期严重的并发症;严格选择手术适应证、缩短手术操作时间、防止酸中毒是降低膜周部室间隔缺损介入封堵术后心律失常发生率的有效措施。