室间隔缺损介入堵闭术中左心室造影投照角度优化探讨

目的 探讨暴露不同类型室间隔缺损（ventricular septal defect,VSD）形态的最佳左心室造影投照角度.方法 回顾性分析2007年1月至2012年12月间267例行封堵治疗的VSD患者的左心室造影资料,其中膜周型179例,肌部型27例,嵴内型61例.所有患者均于术前常规以左前斜位（left anterioroblique,LAO）60°＋头位（cranial,CRA）20°行左心室造影,肌部型患者加用LAO70°＋CRA20°、嵴内型患者加用LAO80°＋CRA20°体位投照.比较在不同造影角度下三种不同类型VSD患者最优显示率.结果 所有患者均成功行左心室造影及介入封堵术,无明显并发症.膜周型179例,LAO60°＋CRA20°能充分显示室间隔形态163例（91.1％）;肌部型27例,LAO60°＋CRA20°充分显示3例（11.1％）,LAO70°＋CRA20°充分显示24例（88.9％）,两者比较差异有统计学意义（P＜0.05）;嵴内型61例,LAO60°＋CRA20°充分显示1例（1.6％）,LAO80°＋CRA20°能充分显示53例（86.9％）,两者比较差异有统计学意义（P＜0.05）.结论 膜周部VSD取LAO60°＋CRA20°投照,肌部VSD取LAO70°＋CRA20°投照,嵴内型VSD取LAO80°＋CRA20°投照角度最为合适.

Discussion on the best angulation for left ventriculography in transcatheter closure of ventricular septal defects with occluder

Objectives To investigate the best angulation for left ventriculography in patients with ventricular septal defects（VSD） receiving catheter closure therapy.Methods Between January 2007 and December 2012,1eft ventriculographic parameters of 267 patients with VSD receiving catheter closure therapy in Guangdong General Hospital were reviewed.Of these cases,perimembranous VSD was observed in 179 patients,intracristal VSD in 61 and muscular VSD in 27.Left ventriculography [left anterior oblique （LAO） 60°＋cranial （CRA） 20°] was performed before transcatheter closure with occlude was carried out in all the patients.Larger angle projections （LAO80°＋CRA20° and LAO70°＋CRA20°） were also performed in patients with intracristal VSD and muscular VSD respectively.Ventriculographic results by different angles were compared among the patients.Results Left ventriculography and interventional therapy were successful in all the patients and no complications were encountered.The shape of VSD was clearly displayed in 163 patients （91.1％,163/ 179） with perimembranous VSD by the original angle （LAO60°＋CRA20°）.The display rate of muscular VSD was 11.1％ （3/27） by the original angle （LAO60°＋CRA20°）,88.9％ （24/27） by the larger angle （LAO70°＋CRA20°）,and the difference was significant （P＜0.05）.The display rate of intracristal VSD was 1.6％ （1/61） by the original angle （LAO60°＋CRA20°）,86.9％ （53/61） by the larger angle （LAO80°＋CRA20°）,and the difference was significant （P＜ 0.05）.Conclusions The best angles for left ventriculography are LAO60°＋CRA20°,LAO70°＋CRA20o and LAO80°＋ CRA20° in patients with perimembranous VSD,muscular VSD and intracristal VSD respectively.