膜周部室间隔缺损介入治疗并发症的分析

目的　探讨膜周部室间隔缺损 (ventricularseptaldefect ,VSD)经导管介入治疗的并发症及其预防。方法　 2 0 0 2年 7月 - 2 0 0 4年 5月 ,2 6 2 (男 138,女 12 4 )例膜周部VSD患儿 ,年龄 2～ 18(9 3± 5 8)岁 ,体重 11.0～ 6 5 .0 (平均 30 5 )kg。 3例合并动脉导管未闭 ,4例合并房间隔缺损 ,1例合并动脉导管未闭和房间隔缺损。结果　 2 6 2例患儿术前经胸超声检测VSD大小为 2 7～ 13.0mm(平均 6 5mm) ,术中心室造影测量VSD大小为 1 3～ 14 .0mm(平均 6 8mm) ,2 5 6 /2 6 2例 (97 7% )封堵成功。所选封堵器大小为 4～ 16mm (平均 8 6mm)。严重并发症 8例 (3 1% )。其中高度房室传导阻滞(atrioventricularconductionblock ,AVB) 5例 (2 0 % ) ,溶血 2例 (0 8% )。封堵器明显移位 1例 (0 4 % )。5例AVB患儿治疗后除 1例术后 5 0d安装永久起搏器外 ,其余 4例均恢复正常窦性心律。溶血患儿经常规治疗后恢复正常。封堵器明显移位则采用心脏外科手术处理。其他并发症有 :1例 (0 4 % )术后 6个月复查有微量残余分流 ;5例 (2 0 % )术后新出现主动脉瓣微量返流 ;4例 (1 6 % )术后新出现三尖瓣少量返流 ;75例 (2 9% )术后出现间歇性加速性交界性心律或加速性室性自主心律伴干扰性房室脱节 ,治疗后均恢复

Complications of transcatheter interventional occlusion of ventricular septal defects

OBJECTIVE: To investigate the complications and their prevention in patients with perimembranous ventricular septal defect (VSD) experiencing transcatheter interventional occlusion. METHODS: From July, 2002 to May, 2004, totally 262 (138 males, 124 females) perimembranous VSD patients underwent transcatheter interventional occlusion in the department. The age ranged from 2 to 18 years (mean 9.3 +/- 5.8 years), and the body weight ranged from 11.0 to 65.0 kg (mean 30.5 kg). The implanted occluder with imported Amplatzer eccentric perimembranous VSD occluder, domestic double-disk, domestic eccentric perimembranous VSD and PDA occluder were attempted in 12, 212, 28 and 6 cases, respectively. Among them, 3 cases were complicated with ductus arteriosus, 4 with atrial septal defects and 1 with patent ductus arteriosus plus atrial septal defect. The associated defects were treated with other occluders at the same time. RESULTS: The diameters of VSD measured by transthoracic echocardiography before occlusion and by ventriculography during the procedure ranged from 2.7 to 13 mm (mean 6.5 mm) and from 1.3 to 14.0 mm (mean 6.8 mm), respectively. The defects in 256 cases (97.7%) were successfully occluded. The implant occluder was from 4 to 16 mm in size. Serious complications occurred in 8 cases (3.1%), including 5 cases of high degree atrioventricular block (AVB) (2.0%), 2 cases of hemolysis (0.8%) and 1 case of displacement of the occluder (0.4%). Amongst 5 cases of high degree AVB, permanent pacemaker was implanted only in 1 case due to high degree AVB 50 days after treatment, whereas the others all recovered. Two cases of hemolysis were completely recovered. One case of occluder displacement was emergently transferred to cardiac surgery. Other complications included residual shunt during 6 month follow-up in 1 case (0.4%), minor aortic regurgitation in 5 cases (2.0%), minor tricuspid regurgitation during 6 month follow-up in 4 cases (1.6%), and accelerated idioventricular rhythm or accelerated atrio-ventricular junctional tachycardia combined with atrioventricular interference-dissociation by ECG in 75 cases (29%) but they recovered after 3 - 5 days of corticosteroid treatment. Forty-one cases (16%) complicated with complete or incomplete right bundle branch block, of whom 50% recovered during follow-up. Still, there were 4 cases (1.6%) who were complicated with complete left bundle branch block but were all recovered during follow-up and 26 cases (10%) who were complicated with intraventricular block. There were no Significant difference in complications between cases who accepted imported Amplatzer occluders and domestic occluders. CONCLUSION: Transcatheter interventional occlusion is a safe, effective and ideal method with low incidence of serious complications for perimembranous VSD. Long term follow-up and clinical research should be carried out to improve the level of VSD interventional therapy.