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.

Transcatheter closure of ventricular septal defects with occluder in 326 cases and follow-up analysis

Objectives To summarize the experience of transcatheter closure of ventricular septal defect （VSD） with occluder in 326 patients,and to retrospectively explore the medium-term follow-up analysis.Methods For the 326 patients with VSD confirmed by clinical examination and transthoracic echocardiography （TTE） to exclude subarterial ventricular septal defect,percutaneous transcatheter closure was performed.Left ventriculography and TTE were used immediately after surgery to assess the effect.TTE,chest X-ray and electrocardiogram （ECG） examination were used in follow-up study at 1 day,1 month,3 months,6 months,1 year,2 years,3 years,4 years,and 5 years respectively.Results The successful rate was 98.3% （320/326）.The causes for procedural failure included oversize or undersize of the VSD dimension,specialty of the VSD position,complication of aortic valve prolapse and regurgitation,tricuspid or aortic valve injury and atrioventricular block etc.Post-operation complications were outlined below：1 patient with device displacement 1 day after procedure needed emergency surgery; 2 patients weighed 8 kg with femoral artery thrombosis after sugery were treated successfully by thrombolytic therapy of urokinase ; Mild tricuspid regurgitation or exacerbation of former tricuspid regurgitation were found in 12 patients; 1 patient met with aortic valve injury causing moderate aortic valve regurgitation,and was cured by emergency surgery; Non-paroxysmal junctional tachycardia occurred in 56 cases,and they recovered to sinus rhythm after treatment with glucocorticoid hormone,albumin and myocardial nourishment; Incomplete bundle branch block occurred in 17 cases and complete left bundle branch block occurred in 5 cases; 1 case showed type Ⅱ second degree atrioventricular block 10 months after occlusion,and recovered to one type Ⅰ second degree atrioventricular block after treatment; Cerebral hemorrhage happened in 1 patient 8 days after procedure,and cerebrovascular malformation was found and treated successfully after surgical operation.By follow-up examination,left ventricular end-diastolic diameter and cardiothoracic ratio improved postoperatively for most of the patients.Conclusions Percutaneous transcatheter closure of VSD has the advantages of less injury,less complications,high successful rate and no cardiopulmonary bypass,thus,it is worthy of popularizing.But it requires standardizing the process of patient selection and long-term follow-up examination.