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。

The effect and follow-up study on transcatheter closure of ventricular septal defects using the homemade VSD occluder

Objective Congenital heart disease (CHD) is the most popular cardiovascular disease of paediatrics. Ventricular septal defect (VSD) accounts for 50%. This study was to evaluate the treatment efficiency of transcatheter closure of ventricular septal defect(VSD) using the homemade occluder device. Methods Seventy-five patients with VSD underwent attempted transcatheter closure using the homemade occluder device at a median age of 8.5 years old (ranging from 3.0 to 14). The mean VSD diameter at its left ventricular side was 6.5±3.6 mm (ranging from 3.0 to 14.0) The left ventricular graphies(LVG) were performed to evaluate the closure results immediately after the operation. Echocardiography and ECG were performed 1 day and 1 month respectively after the closure to find whether there was residual shunt or recanalization. Results ①The technical success rate of the group was 98.7%. ②LVG showed that 65（87.8%） patients had complete closure immediately after the operation, 9（12.2%） had a trivial to small shunt immediately after the operation. Within 24-48 h, color Doppler revealed complete closure in 74 patients（98.7%） and a trivial to small shunt in 2 patients（2.3%）.Two cases had Ⅲ°atrial ventricular block and returned to normal after 4-10 days with medical treatment. One patient developed hemolysis 24h after the operation and recovered after 7 days with medical treatment. ③ Echocardiography revealed complete closure in 71 patients（94.7%） and a trivial to small shunt in 2 patients（2.7%）1 month after the operation. ④ There were 70, 68, 21, 15,and 12 patients who were followed up 3 months, 6 months, 1 year, 2 years, and 3 years after the operation, respectively. Two cases who had a trivial to small shunt recovered after 3 months and 6 months respectively. Conclusions Transcatheter method of VSD occlusion using homemade VSD occluder is safe and effective. It had a high technical success rate, satisfied and reliable immediate and short-term results. Further clinical trials should be undertaken to assess the long-term safety and results.