经导管应用Amplatzer封堵器关闭膜周部室间隔缺损

目的 :经导管应用Amplatzer封堵器关闭膜周部室间隔缺损 (perimembranousventricularseptaldefect,PMVSD) ,并对其疗效进行初步分析。方法 :18例室间隔缺损 (VSD)中男性 8例 ,女性 10例 ,平均年龄 7 6岁 ,平均体重 2 6 9kg。局麻下行右心导管检查 ,左室造影测量室缺大小 ,经VSD建立股动脉 股静脉轨道 ,封堵器沿传送装置送至左室 ,打开左侧伞并确认铂金标记 (MARK)位于 6点位 ,指向心尖 ,在室间隔右室侧打开右侧伞 ,经超声心动图和左室造影确认封堵器位置良好 ,无残余分流 ,无三尖瓣及主动脉瓣关闭不全后释放封堵器。结果 :18例VSD患者封堵手术均获成功。VSD平均大小 3 9mm ,所选封堵器平均大小 7 1mm ,放射线观察MARK均在 6点位置。封堵效果良好 ,术后 2 4h左室舒张末径明显缩小 ;术后 2 4h仅 2例有微量残余分流 ,无 1例出现主动脉瓣关闭不全 ,无其它严重并发症 ,平均住院3 5d。结论 :经导管应用Amplatzer封堵器关闭膜周部VSD封堵效果好 ,恢复快 ,免除开胸创伤及体外循环等高风险 ,值得进一步推广。

Transcatheter closure of perimembranous ventricular septal defects with Amplatzer device

Objective: This study is to report the transcatheter closure of perimembranous ventricular septal defects(PMVSD) utilizing the Amplatzer membranous occluder device (AGA Medical Corporation). Method: Catheter closure of VSD using an Amplatzer membranous VSD device was attempted in 18 patients(10F/8M, age 3～26 years with a median of 7.6 years, Wt.14～64 kg with a median of 26.9 kg). Routine heart catheterization and angiography LV(LAO 60, Cran 20)were carried out after local anesthesia. The size of the VSD were measured by X-ray and TTE. Arteriovenous loop was set up routinely. The device was transmitted into left ventricle through sheath and two disks were deployed in left and right ventricle respectively and kept the mark of the left disc toward to apex all the time. After it was verified by TTE and LV angiography that the position of device was correctly inside ventricles and there was no residual shunt, aortic valve and tricuspid valve insufficiency, the device was released.Result:Total procedures were attempted in 18 patients successfully. The average size of VSDs and devices was 3.9 mm (range from 2.5 to 7 mm) and 6.5 mm (range from 4 to 12 mm). Complete closure was identified in 17/18 patients. There was only one patient with trace residual shunt 24 h after operation. Left ventricle end-diastolic dimensions were reduced significantly. There was no aotic insufficiency and other severe complication. The average hospital stay was 3.5 days. Conclusion:Catheter closure of VSD using an Amplatzer membranous VSD device yields good results avoiding the high risk of surgical trauma, bypass and general anesthesia. It is worthwhile to be used widely in membranous VSD closure.