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.     

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。     

单纯超声心动图引导下经皮室间隔缺损封堵术的应用研究

目的:传统经皮室间隔缺损(VSD)封堵术存在放射线及造影剂损伤,本文探讨单纯超声心动图引导下进行经皮VSD封堵术的有效性和安全性。方法:于2014-02至2014-10期间入选先天性VSD患者28例,平均年龄(9.5±3.1)岁,平均体重(31.3±7.7)kg,平均VSD直径(4.6±0.9)mm。患者均在经胸超声心动图引导下行经皮VSD封堵术,封堵后以超声心动图检查评价治疗效果。术后1、3、6、12个月在门诊随访。结果:26例患者在经胸超声心动图引导下成功完成经皮VSD封堵术,1例患者因导管未能沿导丝通过VSD,改超声心动图引导下经胸小切口封堵成功,1例患者因残余分流大于2 mm,改常规外科手术治疗成功。患者的平均手术时间为(63.3±11.7)min,对称型VSD封堵器直径(6.6±1.0)mm;术后即刻微量残余分流2例;平均住院时间为(3.7±1.3)d。所有患者康复出院,无外周血管损伤及心包填塞等并发症。患者术后的平均随访时间为(6.2±3.4)个月,随访1个月时2例患者微量残余分流消失,所有患者未出现心包积液、封堵器脱落、房室传导阻滞和主动脉瓣反流等并发症。结论:单纯超声心动图引导下经皮VSD封堵术不仅安全有效,而且能避免使用放射线及造影剂。     

介入封堵治疗室间隔缺损合并轻中度右冠状瓣脱垂的疗效观察

目的评价介入封堵治疗室间隔缺损(VSD)合并轻、中度右冠状瓣脱垂的有效性及安全性。方法选择2015年5月至2018年4月湖南省儿童医院收治的VSD患儿作为研究对象,术前经胸超声心动图(TTE)和(或)经食管超声心动图(TEE)诊断VSD合并轻、中度右冠状瓣脱垂,采用经导管介入封堵治疗75例(男40例,女35例)。术中通过造影及TTE检查有无残余分流、新发主动脉瓣反流或原有主动脉瓣反流加重,体表心电图评估介入封堵后是否影响传导系统。术后通过TTE和体表心电图对患儿进行随访,重点观察主动脉瓣反流程度和有无心脏传导阻滞。结果 75例患儿平均年龄(51.8±34.6)个月,平均体重(16.7±7.3)kg;嵴内型VSD 31例,膜周型VSD 44例;右冠状瓣脱垂轻度53例,中度22例。其中术前三尖瓣轻度反流3例,主动脉瓣轻度反流1例;应用对称型VSD封堵器24例,偏心型VSD封堵器30例,ADOⅡ封堵器21例。术后三尖瓣反流3例(同术前),主动脉瓣轻度反流7例(其中1例同术前),残余漏4例(术后6个月消失),室性早搏1例,三度房室传导阻滞1例(外科取伞并修补VSD后恢复窦性心律),封堵器脱落1例(紧急外科取伞并修补VSD),无左束支传导阻滞、机械性溶血发生。不同程度右冠状瓣脱垂VSD封堵术后主动脉瓣反流比较,差异有统计学意义(P=0.002);不同类型VSD封堵术后主动脉瓣反流比较,差异无统计学意义(P0.999)。嵴内型VSD与膜周型VSD患儿手术时间[(15.00±12.66)min比(19.68±13.48)min,P=0.028]、辐射剂量[(93.97±51.45)m Gy比(123.93±58.85)m Gy,P=0.005]比较,差异均有统计学意义。术前与术后6个月左心室舒张末期内径[(31.20±3.59)mm比(27.45±2.96)mm,P=0.096]、左心室收缩末期内径[(19.60±2.22)mm比(16.71±1.87)mm,P=0.098]比较,差异均无统计学意义;而左心室射血分数[(63.85±4.77)%比(66.37±3.05)%,P=0.010]比较,差异有统计学意义。结论通过介入封堵治疗合并轻、中度右冠状瓣脱垂VSD是可行的,但仍需长期随访评价其远期疗效,及更大样本量评估术后效果。     

三尖瓣腱索附着异常的膜周部室间隔缺损介入治疗初步探讨

目的:探讨三尖瓣腱索附着异常的膜周部室间隔缺损(VSD)应用特制的"类柱状封堵器"介入治疗的可行性及近期疗效观察.方法:术前超声检查筛选出5例VSD的患者均伴有三尖瓣腱索附着异常.5例患者均选择特制"类柱状封堵器"堵闭VSD.术后24 h、1个月、6个月行超声心动图、心电图检查随访观察.结果:5例患者均一次封堵成功.术后复查心电图,未发现严重新发的心律失常.术后24 h超声心动图检查,封堵器形态、位置良好;4例心腔大小较术前均有所缩小,1例缺损较小,心腔大小正常无明显变化;三尖瓣反流1例较术前增多.术后6个月超声心动图检查,4例心腔大小均回缩至正常;1例心腔大小正常患者无明显变化;1例较术前三尖瓣反流量增多患者术后1个月、6个月均无明显变化;无其他并发症发生.结论:特制"类柱状封堵器"可用于三尖瓣腱索附着异常的膜周部VSD介入治疗中,即刻及近期疗效可靠,未发现严重的三尖瓣反流及其他并发症.     

经胸微创室间隔缺损封堵术50例疗效分析

目的:初步总结经胸微创室间隔缺损(ventricular septal defect,VSD)封堵术临床经验和近期疗效。方法:50例诊断明确的单纯VSD患者,气管插管全身麻醉后,经胸壁切口进入心包腔,于右心室表面合适位置缝置荷包并切开,在食管超声监测下,采用中空探条辅助或直接输送法将封堵器安放在VSD部位,若无异常情况即可释放封堵器。结果:49例封堵成功,1例术中改为常规体外循环手术。封堵成功者中,选用对称伞46例,偏心伞3例。3例发生新的微量至轻度三尖瓣反流,3例术后发生不完全右束支传导阻滞,1例术后拔除心包引流管后残存心包积液,经心包穿刺后痊愈。49例患者围术期及近期随访无死亡、无完全性房室传导阻滞、无残余分流发生、无新发主动脉瓣关闭不全。结论:经胸微创VSD封堵术具有手术创伤小,安全性高等优点,近期疗效好,远期疗效尚需进一步观察。     

偏心型封堵器治疗先天性干下型室间隔缺损的探讨

目的探讨先天性干下型室间隔缺损(VSD)偏心型封堵器介入治疗的可行性及近期疗效。方法经皮介入治疗先天性干下型室间隔缺损患者7例。经胸超声心动图提示VSD的直径为4~8mm,缺损上缘距主动脉瓣的距离1~2mm,距肺动脉瓣距离4~6mm,轻度主动脉瓣反流6例,中度1例。均选用偏心型VSD封堵器治疗。术中在右前斜45度下行左室造影、建立股动静脉轨道、经右心系统释放封堵器,并分别于术后2周、1个月、3个月、6个月进行随访。结果7例患者封堵器均成功置入。术后即刻超声及造影示完全封堵6例,少量残余分流1例,在3个月后消失。封堵器对主动脉瓣、肺动脉瓣和房室瓣均无影响,术中及术后未有其它严重并发症发生。结论应用偏心型封堵器经皮介入治疗先天性干下型室间隔缺损是安全有效的,近期效果良好。     

介入封堵治疗单纯主动脉窦瘤破裂的临床疗效及随访结果

目的:探讨经导管介入封堵主动脉窦瘤破裂的临床疗效和中/远期随访效果。方法:9例右冠状窦和3例无冠状窦破入右心房患者进行介入封堵治疗,术后超声随访观察2~7年,结果:11例采用国产蘑菇伞封堵器,1例采用Amplazer蘑菇伞封堵器;11例患者一次封堵后无残余分流、封堵成功;1例患者封堵器到位后超声和造影均有分流,经调整封堵器、观察20分钟后残余分流消失。12例术后1周左心室舒末径均较术前明显改善,封堵器对瘤壁及冠状动脉开口、主动脉瓣无影响。12例患者术后随访2~7年,平均(4.75±1.34)年,超声心动图均未见异常分流及反流。结论:应用国产蘑菇伞封堵器介入治疗主动脉窦瘤破裂安全、可靠,中期和远期疗效满意。     

室间隔缺损经导管封堵术中及术后并发心律失常的临床分析

目的:分析室间隔缺损(VSD)封堵治疗术中、术后并发的心律失常的类型,探讨其发生的原因及防治措施. 方法:选择2003年1月至2006年10月在我科行封堵治疗的115例VSD患者,结合临床资料、心电图、心脏超声、心血管造影资料及随访结果,分析封堵术中及术后并发心律失常的类型、相关因素及转归. 结果:术中出现三度房室传导阻滞(Ⅲ°AVB)2例,室性心动过速2例;术后并发各种类型的传导阻滞共37例,其中Ⅲ°AVB 8例、不完全性右束支传导阻滞(IRBBB)14例,完全性右束支传导阻滞(CRBBB)5例,完全性左束支传导阻滞(CLBBB)4例,左前分支传导阻滞(LABBB)6例.分析其发病原因,均与封堵器直径≥10 mm有密切相关性,而与合并膜部瘤及操作时间无关. 结论:心律失常是VSD封堵治疗术常见的并发症,严格选择手术适应证,避免采用直径过大的封堵器是减少VSD封堵术后心律失常的有效措施.     

室间隔缺损并发主动脉瓣脱垂的介入治疗及评价

目的:探讨室间隔缺损(VSD)并发轻度主动脉瓣脱垂(AVP)的介入治疗的可行性,并评价其近中期疗效。方法:采用国产新型VSD封堵器对27例并发AVP的VSD患者进行封堵治疗,经胸超声心动图显示VSD的直径。所有患者术后进行定期随访。结果:27例患者中,嵴内型VSD10例,膜周部VSD17例,皆不伴主动脉瓣关闭不全,其中右冠瓣脱垂20例,左冠瓣脱垂6例,右冠瓣脱垂并无冠瓣脱垂1例;左心室造影显示缺损直径2～12(4.54±1.93)mm,缺损上缘距主动脉瓣0～1(0.35±0.25)mm。27例患者封堵成功22例,成功率81.5%。封堵成功的22例患者术后即刻左心室造影及心脏超声检查无分流、无主动脉瓣及三尖瓣反流。术后随访6～30(平均18)个月,未发生主动脉瓣穿孔或反流,亦无二尖瓣和三尖瓣关闭不全,未出现新发心律失常。结论:国产VSD封堵器可以成功封堵并发轻度AVP的VSD,近中期疗效佳,远期疗效需要进一步随访观察。     

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.     

应用国产对称双盘封堵器经导管治疗膜周部室间隔缺损的临床疗效

目的评价应用国产对称双盘封堵器经导管治疗室间隔缺损的安全性及有效性。方法自2003年3月至2007年7月,对我科689例室间隔缺损患者应用国产对称双盘封堵器经导管进行了室间隔缺损的介入治疗,合并房间隔缺损、动脉导管未闭等均进行了同期治疗。并进行术中,术后第1、3、6个月及每年随访,包括12导联心电图及超声心动图检查,观察并发症的情况（有无房室传导阻滞、封堵器形态、对主动脉瓣及三尖瓣的影响以及有无残余分流等）,评估该方法的安全有效性。结果总体技术成功率为98.8%。因术后脑出血死亡1例,因Ⅲ度房室传导阻滞安装永久性心脏起搏器1例,半年后因三尖瓣中-重度关闭不全转外科手术1例,6例改用Amplatzer偏心伞进行封堵成功;2例封堵失败转外科手术。其余随访期间未出现明显并发症。结论应用国产对称双盘封堵器经导管治疗室间隔缺损术后出现各种与手术有关的并发症的几率较低,具有很强的安全性和可行性,应成为室间隔缺损患者的首选治疗方案,但同时应掌握好适应证,注意三尖瓣关闭不全等并发症的预防。     

The Amplatzer Membranous VSD Occluder and the vulnerability of the atrioventricular conduction system

Transcatheter closure of ventricular septal defects with the Amplatzer Membranous VSD Occluder has yielded promising initial results, but disturbances of conduction, including complete heart block, have been reported. We report our experience with the Amplatzer occluder in 35 patients with a median age 4.5 years, the defects being sized angiographically at 4.4 plus or minus 1.1 millimetres, with a range from 3 to 8 millimetres, and the size of the occluder varying from 4 to 12 millimetres. Over a median follow-up of 2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2 years respectively, while 2 patients required surgical closure of the defect subsequent to the insertion of the device. Persistent regurgitation across the tricuspid valve related to the occluder was observed in 3 patients, and in 6 patients across the aortic valve. Abnormalities of conduction related to the procedure were noted in 7 patients, one-fifth of the cohort. The disturbances were transient in 1 patient, but permanent in 6, in one of the latter progressing after 6 months from left bundle branch block to intermittent Mobitz II second-degree atrioventricular block in association with expansion of the occluder. We conclude that transcatheter closure of perimembranous ventricular septal defects with the Amplatzer occluder is effective with limited complications, but the incidence of immediate and progressive disturbances of conduction related to the proximity of conduction tissues to the rims of the occluder stress the importance of larger and longer studies to assess the safety of this procedure.     

Transcatheter closure of perimembranous ventricular septal defects using amplatzer asymmetric ventricular septal defect occluder: preliminary experience with 18-month follow up.

BACKGROUND: This study reports our experience in the nonsurgical closure of perimembranous ventricular septal defects in children and adolescents with the Amplatzer asymmetric ventricular septal defect occluder and the outcome of an 18-month follow up. METHODS AND RESULTS: Twenty patients (median age:10 years; median weight:32 kg) with perimembranous ventricular septal defect were selected for transcatheter closure with the Amplatzer device. The prosthesis diameter chosen was 1-2 mm larger than the largest measured diameter of the defect on transesophageal echo (TEE). All patients were put on oral aspirin (5 mg/kg/day in children and 150 mg/day in adults) five days prior to and for six months after closure. Follow-up evaluation at 48 hr and 1, 6, 12 and 18 months included clinical examination, electrocardiogram, and a transthoracic echocardiogram. The mean defect diameter on color flow mapping on TEE was 7.1 +/- 2.3 mm. The device diameter ranged from 6-14 mm (median = 8 mm). One patient developed an anaphylactic reaction to contrast. The procedure was successful in 17 out of 19 patients where it was attempted (89.4%). In two patients with associated significant aortic valve prolapse and mild aortic regurgitation the device could not be successfully deployed. A trivial residual shunt observed during postdeployment left ventricular angiogram in 7 of 17 patients (41.2%) completely disappeared at one month follow-up. Three patients had right bundle branch block (2 complete and 1 incomplete) whereas one developed junctional escape rhythm with a right bundle branch block morphology. One patient had clinically silent thromboembolism to the left vertebral artery and another patient had hemolysis which resolved spontaneously within 48 hr. Follow-up at 13.5 +/- 5.3 months (range 1-18 months) revealed no residual shunt. The left ventricular internal dimension in diastole decreased significantly from 45 +/- 6 mm to 40 +/- 6 mm (P < 0.01) at the time of the last follow up. The baseline tricuspid regurgitation (n = 4) and aortic regurgitation (n = 3) remained unchanged during the follow up period. None of the patients developed left ventricular outflow tract obstruction or new aortic or tricuspid regurgitation. There were no other device related complications such as device migration, systemic thromboembolism, infective endocarditis, pericardial effusion or delayed conduction disturbances. CONCLUSIONS: In carefully selected children and young adults, the Amplatzer asymmetric ventricular septal defect occluder is a promising device for transcatheter closure of perimembranous ventricular septal defect with encouraging results on short term follow up.     

国产动脉导管封堵器闭合膜周部室间隔缺损的疗效评价

目的评价国产动脉导管（PDA）封堵器闭合膜周部室间隔缺损（VSD）的可行性、安全性及疗效。方法2004年5月至2008年7月,21例先天性膜周部VSD患者[男性10例,女性11例,年龄5～40（21．3±10．2）岁]成功接受了封堵治疗。膜周部VSD的直径均先经经胸心脏彩超检查（TTE）测量,并经左心室造影进一步明确。封堵操作完成10min后再次予TTE及左心室造影评估封堵效果。术后心电监护1周,出院前及出院后1、3、6个月随访复查TTE及心电图。结果21例患者均全部封堵成功,国产PDA封堵器尺寸为6／8～18／20mm。封堵后,2例新出现微量主动脉瓣反流,1例出现少量的三尖瓣反流;3例出现完全性或不完全性右束支传导阻滞,1例出现完全性左束支传导阻滞,1例出现不完全右束支合并间歇性完全性左束支传导阻滞,除2例完全性或不完全性右束支传导阻滞在6个月内随访时未恢复外,其他3例均在出院前恢复正常;4例存在微量残余分流,其中3例在7d后复查超声时消失,另1例在1个月随访时消失。术前TTE估测肺动脉压力为28．0～46．7（33．4±9．2）mmHg,术后肺动脉压力为16．0-30．2（19．2±7．6）mmHg,6个月随访时肺动脉压力进一步下降为15．3-26．7（17．3±6．9）mmHg。结论对部分膜周部室间隔缺损的患者应用PDA封堵器进行封堵是可行的、安全的及有效的。     

室间隔缺损介入封堵治疗发生心律失常的临床研究

目的探讨室间隔缺损(VSD)经导管介入治疗发生心律失常的机制及防治对策。方法对79例VSD患者进行介入封堵治疗。膜周部VSD单纯型50例,膨出瘤型28例,肌部VSD1例。选用Rashkind双伞闭合器2例,Sideris钮扣闭合装置16例,Amplatzer PDA封堵器45例,Amplatzer偏心型膜周部封堵器11例,Am-platzer肌部VSD封堵器1例。结果79例患者75例封堵成功(94.9%)。术后新出现心律失常31例(41.3%),其中不完全性右束支传导阻滞17例(22.7%),完全性右束支传导阻滞3例(4%),完全性左束支传导阻滞6例(8%),室性早搏3例(4%),间歇性室上性心动过速2例(2.7%)。1例患者术前心电图示完全性右束支传导阻滞,术后第4天心电图表现为Ⅲ度房室传导阻滞,临床伴发阿—斯综合征。经紧急开胸心脏挤压,气管插管,安置心外膜临时起搏器,复苏成功,出院时患者心电图恢复至术前状态。其余25例束支传导阻滞,其中5例应用强的松30mg/日,一周后仅有2例存在不完全性右束支传导阻滞,1例存在不完全性左束支传导阻滞。3例室性早搏,2例为一过性,1例经抗心律失常药物治疗,出院时室性早搏仍有591次/24小时。结论经导管封堵VSD,出现心律失常达41.3%,但严重心律失常发生率低,是安全、有效可靠的治疗方法。     

Transcatheter closure of congenital muscular ventricular septal defect

The success with occlusion devices for the closure of atrial septal defects and patent ductus arteriosus prompted the transcatheter closure of single and multiple muscular ventricular septal defects (VSD). The procedure for VSD was first attempted by Lock et al. in 1988 and devices originally designed for the closure of other intracardiac defects (Rashkind umbrella device, Lock clamshell, Cardioseal, coils, Sideris buttoned device etc.) were used with a variable success rate and a residual shunt. Recently, specially designed Amplatzer muscular VSD occluder and Sideris device are in use. The Amplatzer muscular VSD occluder has been undergoing clinical trial since 1998 after the animal experiments had shown 100% occlusion and complete endothelization at 3 months. The procedure was first attempted in August 1995 using the Rashkind umbrella device and since April 1998 only the Amplatzer muscular VSD occluder has been used. Of the149 patients who underwent transcatheter closure of VSD, 50 had muscular trabecular defects in various locations: mid-muscular, anterior, posterior, or apical. All cases were selected by detailed transthoracic and/or transesophageal echocardiography (TTE) and aneurysm of the muscular septum was observed in three of them. The age range was 3-28 years and the diameter of VSD was 4-11 mm. In all but one patient, the device was deployed from the venous side. Simultaneous TTE was done for proper positioning of the device and continuous electrocardiographic monitoring was also done for any arrhythmia/conduction defects. All patients were followed up every 3 months and received 3-5 mg/kg aspirin for 6 months. The procedure was successful in all patients. The Rashkind umbrella device (17 mm) was used in two and Amplatzer muscular VSD occluder (6-14 mm) in 48 patients. Forty-four devices were delivered by antegrade transvenous approach and six by the transjugular route. None had residual shunt, new aortic regurgitation, or tricuspid regurgitation. Transient complete heart block after 24 hours was noticed in one patient. On a follow-up of 2-90 months, the device was in position in all patients. There was no embolization of the device, and no late-conduction defects, infective endocarditis, or hemolysis. Transcatheter closure of muscular VSD is safe and efficacious, and should be considered as a procedure of choice as an alternative to surgery that avoids cardiopulmonary bypass.     

封堵器介入治疗室间隔缺损失败原因影像学分析

目的 用影像学方法分析封堵器介入治疗室间隔缺损的失败病例,以提高介入治疗室间隔缺损手术成功率。方法 未能成功行室间隔缺损堵闭术47例（47/774）,男27例,女20例,年龄2～30岁。对比其手术前后左心室和主动脉造影影像资料。结果 膜部瘤破裂15例,其中8例有多个破口,堵闭主要破口后仍有其他的破口分流,2例术前造影只显示单个破口,堵闭破口后出现新的破口,5例封闭基底部后仍存在大量分流;放置堵闭器后出现了中度以上的主动脉瓣反流28例,7例高位嵴下型室间隔缺损,室间隔缺损上缘到主动脉瓣距离小于适应证标准。21例伴有主动脉瓣脱垂,封堵器影响主动脉瓣从而造成主动脉关闭不全;封堵器移位2例;2例术后出现溶血。结论 封堵器介入治疗室间隔缺损是安全可靠的治疗方法,但是应该严格把握适应证,恰当地选择堵闭方式和堵闭器,避免治疗失败及术后并发症。     

经导管室间隔缺损封堵术与外科手术治疗膜周部室间隔缺损的对比研究

目的　分析比较经导管室间隔缺损封堵术 (TCVSD)与外科修补术治疗膜周部室间隔缺损的疗效及优缺点 ,为临床提供优选依据。方法　外科组包括接受外科手术治疗的 4 5例膜周部室间隔缺损 (VSD)患者 ,采用直接缝合或补片修补VSD ;TCVSD组包括同期接受TCVSD术的 4 5例膜周部VSD患者 ,采用新型偏心状Amplatzer膜周部室间隔缺损封堵器封堵VSD。比较两组的疗效、并发症和费用等情况。结果　TCVSD组 4 4例封堵成功 (技术成功率 98% ) ,术后出现少量残余分流3例 (均小于 2mm) ,出现完全性左束支传导阻滞 1例 ,无其他严重并发症发生 ;外科手术组全部手术成功 ,无死亡 ,术后出现残余分流 1例 (3～ 4mm) ,心包积液 1例 (后行切开引流术 ) ,切口内出血 1例(后行二次缝合术 ) ,左前分支阻滞 2例。两组间治疗前后左室舒张末径 (LVEDD)的减小程度无明显差异 (P >0 0 5 ) ,总住院天数及特护天数TCVSD组要明显少于外科组 ,治疗总费用及器材费TCVSD组要明显高于外科组。结论　TCVSD术疗效与外科手术相当 ,具有并发症较少 ,术后恢复快 ,不留疤痕等优点 ,但治疗费用较高 ;对于部分选择性病例 ,TCVSD术可以逐步替代外科手术成为治疗膜周部VSD的首选方法。     

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.