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.

Mini-invasive perventricular device closure of perimembranous ventricular septal defects via a modified skin approach

Objective To explore the safety and feasibility of perventricular device closure of perimembranous ventricular septal defects (pmVSDs).Methods From May 2011 and May 2015,a total of 289 patients with pmVSDs were enrolled.The procedure was performed without sternotomy via a new transthoracic approach of 1 to 2 cm.Device selection and operative process were monitored by transesophagealechocardiogram.Follow ups were conducted postoperatively by echocardiography and electrocardiogram at 1 month,3 months,6 months and annually.Results The defects were closed successfully in 277 patients (95.8 ％) and the remainder required a conversion into conventional surgical repair.A modified incision of (1 ～2)(1.53 ± 0.46) cm was performed.Neither pericardial drainage nor hydropericardium occurred in early postoperative period.The size range of pmVSDs was (3～ 10)(5.30 ± 2.88) rnm.And occluders sized (4～12) (6.70 ± 3.10) mm were implanted,including symmetric (n =191) and asymmetric (n =86) devices.Trivial residual shunt was present in 12 patients (4.3 ％).Nine patients (3.2 ％) developed incomplete right bundle branch block.One patient had intermittent complete atrioventricular block at Day 4 post-operation and sinus rhythm was restored by corticosteroids after 5 days.The average hospital stay was 3.2 ± 0.8 days.During follow-ups,there was no occurrence of aortic regurgitation,malignant arrhythmia or device dislocation.However,trivial residual shunt persisted in 4 patients (1.4％).Conclusions Perventricular device closure through a modified transthoracic approach without sternotomy is both safe and effective for pmVSDs.Controlled efficacy studies with long-term follow-ups are warranted.