经主动脉瓣上释放封堵器左室伞盘闭合室间隔缺损的临床探讨

目的探讨封堵室间隔缺损（VSD）时封堵器左室伞盘经主动脉瓣上释放的临床疗效及安全性。方法根据经胸超声心动图（TTE）选择符合介入治疗条件的27例VSD患者,常规建立导丝轨道,输送长鞘沿导丝轨道从右室侧通过VSD进入主动脉瓣上,不按常规方法使传送鞘管头端进入左心室心尖处,而是在主动脉瓣上释放封堵器左室伞盘,而后回撤跨过主动脉瓣,按常规释放右室伞盘。经TTE检查和左心室造影（LVG）确认封堵成功后释放封堵器。结果27例患者全部封堵成功。1次封堵成功24例,再次更换封堵器封堵成功3例。左心室造影VSD直径为4～11mm,封堵器为6～12mm。所有患者术后即刻心脏杂音消失、TTE及LVG检查确认封堵成功。操作时间28～75（46±10）min,X线透视时间12～21（11.6±3.8）min。术后3d、1个月及6个月分别行TTE、心电图、X线检查,全部患者无残余分流,封堵器位置固定良好,无严重并发症发生。结论封堵器经主动脉瓣上释放左室伞盘的方法封堵VSD安全、高效,特别适用于难度较大的VSD封堵,该方法简化了封堵器释放程序,缩短了操作及透视时间,减少了并发症的发生,手术成功率高,疗效可靠,值得推广。

Clinical Obeserve on the Method of Releasing Left Plate of Occluder above Aortic Valve for Occlusion of Ventricular Septal Defect

Objective To evaluate the efficacy and safety of the method of releasing left plate of occluder above aortic valve for occlusion of ventricular septal defect（VSD）.Methods 27 patients with VSD diagnosed as transthoracic echocardiography（TTE） and left ventriculography （LVG） were suitable to interventional therapy. They were treated according to following method, setting up a path with the wire passing a femoral vein, right ventricle, VSD, left ventricle and a femoral artery by the routine. The left plate of occluder device would be released above the aortic valve without the transport system reaching to 1eft ventricular apex.TEE and LVG would be done to evaluate the interventiona1 therapy.Results All of 27 patients were treated successfully.24 cases were done once,3 cases were done twice. The diameter of VSD was 4-11mm,the diameter of occluder was 6-12mm;the cardiac murmur disappeared immediately after the interventional therapy. The successful operations were confirmed by TTE and LVG. The operation time was 28-75（46±10）min. The exposed time of X-ray was 12-21（11.6±3.8）min. It was confirmed that no residua1 shunt and aortic valve insufficiency were found and the position of the occluder was safe by the examination of TTE, electrocardiograms and X-ray on the 3 rd day and 1 month and 6 month after the therapy. Conclusion The method of releasing left plate of occluder above aortic valve for occlusion of ventricular septal defect is effective and safe,and is suitable especially for occlusion of young children. In such cases the delivery sheath could be advanced across the VSD repeatedly and lead to the failure of procedure. This method simplified the procedure of releasing of occluder, reduced exposed time of X-ray, increased success rate of operation and therapeutic effectiveness is reliable. The method is well worth of popularization.