经导管介入封堵术治疗儿童室间隔缺损36例临床分析

目的探讨经导管治疗儿童先天性心脏病室间隔缺损封堵术的可行性及安全性,进行多方面综合疗效评价。方法通过经胸超声心动图（TTE）选择适合封堵术的先天性心脏病室间隔缺损（VSD）患儿36例,术前常规检测心电图（ECG）,胸部X线等,房间隔缺损（ASD）合并VSD 1例。在TTE及X线引导下行介入封堵术,术后通过胸片、心电图和TTE进行动态的随访观察。结果35例患儿封堵成功,技术成功率为97.2%,1例（2.8%）手术失败,改为体外循环下矫正畸形。术后5例病人有少量残余分流,2例出现房室传导阻滞（AVB）,1例出现完全性右束支传导阻滞（RBBB）,1例出现不完全性左束支传导阻滞（iLBBB）,封堵器脱落1例,心包填塞（PT）1例。VSD术前TTE测量值与术中X线测量值比较,差异无统计学意义。术后75%以上病人接受了3~6个月随访,35%以上病人接受了12个月随访,X线及TTE检查：全部显示肺血流量减少,右心房、右心室缩小,心电图提示无明显心律失常发生。结论经导管先天性心脏病封堵术治疗VSD具有很高的成功率及安全性;介入封堵术疗效好,并发症少,术后恢复快;TTE和X线可以准确地应用于先天性心脏病封堵术中。

Clinical Analysis of Trans-Catheter Defect Closure in Treating 36 Cases of Children''''s Ventricular Septal Defect

[Objective] To explore the safety and feasibility of trans-catheter defect closure in treating children's ventricular septal defect and make a comprehensive evaluation on its efficacy.[Methods] 36 patients with ventricular septal defect(VSD) were chosen using transthoracic echocardiography(TTE),routine pre-operation ECG and chest X-ray were conducted;1 case was ASD complicating VSD;defect closure was performed under the guidance of TTE and X-ray;post-operation follow-up was made through ECG,chest X-ray and TTE.[Results] 35 operations out of 36 were successful(97.2%),one failed(2.8%) and was changed to rectifying abnormity in CPB;trace residual shunt in 5 patients,atrial ventricular block(AVB) in 2 patients;incomplete right bundle branch block(iRBBB) in 1 patient,left bundle branch block(LBBB) in 1 patient and occlusion shedding in one patient were observed;no significant difference was found in the TTE measurement before and after the operation;over 75% and 35% of the cases were followed up for 3~6 months and 12 months respectively after the closure;TTE and chest X-ray result demonstrated that right atrium and right ventricle of all the patients diminuted;ECG result showed no obvious arrhythmogenesis.[Conclusion] With high successful rate and safety,trans-catheter closure has good efficacy and few complications in treating ventricular septal defect(VSD);TTE and X-ray are accurate and applicable to trans-catheter closure of congenital heart disease.