室间隔缺损介入治疗中封堵器的选择

目的探讨介入治疗儿童室间隔缺损(VSD)时不同类型国产封堵器的选择方法及介入治疗VSD的可行性、安全性和疗效。方法介入治疗VSD患儿226例。年龄2~14岁(5.62岁);其中膜部VSD209例,嵴内型VSD14例,肌部VSD3例。封堵后再次行经胸超声心动图及左室造影,出院前及术后1、6和12个月复查心电图和超声心动图进行随访。结果211例患者封堵成功,技术成功率93.4%。其中7例应用小腰大边型VSD膜部封堵器,191例应用对称型VSD膜部封堵器,12例应用偏心型VSD膜部封堵器,另1例应用肌部VSD封堵器封堵成功。术中术后无严重并发症发生。结论应用不同类型国产封堵器介入治疗儿童VSD安全有效。根据VSD类型及形态特征合理选择不同类型封堵器十分关键,一般对称型封堵器适用于大多数VSD且易于放置到位,在某些情况下其他形态封堵器是必要的。

Selection of Different Occluders in Transcatheter Closure of Congenital Ventricular Septal Defect in Children

Objective To discuss the methods of selecting different shapes occluder and to evaluate the feasibility,safety and efficacy of them in transcatheter closures of congenital ventricular septal defect (VSD) in children.Methods Transcatheter closures were performed in 226 children with congenital VSD,age ranging from 2 to 14 years(mean 5.62 years) under the guidance of transthoracic echocardiography(TTE) and fluoroscopy.There were 14 patients with intracristal VSD,209 patients with perimembranous VSD and 3 patients with muscular VSD.Left ventriculography and transthoracic echocardiography were performed repeatedly after the procedure to assess the effect of occlusion.The echocardiography and electrocardiography were scheduled before discharge,1,6 and 12 months for the follow-up.Results The occluders were deployed successfully in 211 patients.The successful rate was 93.4%.Thin waist shape occluders,were deployed in 7 patients;equal side shape occluders,were deployed in 191 patients;eccentric shape occluders were deployed in 12 patients,and muscular defect occluders were deployed in 1 patient.There were no complications encountered during or after closure.Conclusions It is very important in transcatheter closure of congenital in children to select different shape occluder according to pathologic characteristics.In general,equal side shape occluder is suita-ble for a large number of defect and it is easy for deployment.In some conditions,the other shape occluder may be necessary.