国产封堵器封堵多出口的膜部瘤型室间隔缺损51例分析

目的 探讨用国产室间隔缺损(VSD)封堵器经导管闭合多出口的膜部瘤型室缺的可行性、安全性和疗效,并总结其技术难点和临床策略.方法 自2008年3月至2012年3月,我院采用国产室间隔缺损封堵器对51例多出口的膜部瘤型VSD行封堵治疗,年龄2～ 36岁.封堵前常规行左心室造影,并测量左室面破口直径为4 ～ 14 mm,平均为(8.7±4.5)mm;右室面均有多个出口,最大破口直径4 ～12 mm平均为(6.8±3.5) mm.根据膜部瘤大小、形态、位置置入不同类型的国产封堵器,封堵后15 min重复造影和经胸超声心动图(TTE)检查并于术后1、6个月随访复查胸片、超声心动图、心电图.结果 根据左室造影的不同形态,将VSD膜部瘤分为漏斗型、囊袋型、菜花型、弯管型4种类型,其中51例多破口的菜花型和囊袋型VSD患者中,术后发生少量残余分流4例,其中3例48小时后消失,1例1个月随访时亦消失.术后2例出现完全性右束支传导阻滞,2例完全性左束支传导阻滞,一过性Ⅲ度房室传导阻滞1例,出院前均恢复.左室舒张末压力(LVEDP)由封堵前的(13.4±4.3) mmHg下降为封堵后的(8.6±3.3)mmHg,下降明显(t=5.34,P＜0.001).左室舒张末经(LVEDD)由封堵前的(48.1±5.3)mm下降为封堵后的(45.7±5.3)mm,下降明显(t=3.85,P ＜0.05).结论 经导管采用国产VSD封堵器治疗多出口的膜部瘤型室间隔缺损疗效可靠、安全性好、并发症少,技术关键是通过对膜部瘤的位置、形态、破口大小及膜部瘤组织牢固程度判断封堵部位及选择合适的封堵器.

Clinical study on catheterization to the pseudoaneurysm of perimembranous ventricular septal defects with domestic occluder devices

Objective To investigate the feasibility,safety and efficacy of transcatheter closure for the the pseudoaneurysm of perimembranous ventricular septal defects ( VSD) with domestic occlude devices made in China. Methods From March 2008 to March 2012,51 patients of VSD with pseudoaneurysm were enrolled in this study. According to the results of the left ventricular angiography,the mean diameter of the left inlet of VSD was ( 8. 7 ± 4. 5) mm,the mean diameter of the right inlet of VSD was ( 6. 8 ± 3. 5) mm and 51 patients had several outlets ( more than 2 outlets) . All patients were treated with domestic occluder devices. Fifteen minutes after the procedure,left ventricular angiography and transthoracic echocardiography ( TTE) were performed. After the procedure,continuous electrocardiogram ( ECG) monitoring lasted for 5 days in all patients,ECG and TTE were performed at month 1 and 6. Results The ventricular septal aneurysm can be classified into four types according to the results of the left ventricular angiography, including the ″funnel″ type,the ″sack″ type,the ″cauliflower″ type,and the ″siphon″ type. The devices were deployed successfully in 51 patients of the ″sack″ type and the ″cauliflower″ type. After the procedure,the VSDs were completely closed in 47 cases and slightly residual shunts ( < 2 mm) was only found in other 4 patients. The residual shunts completely disappeared in 3 patients 48 hours later,and the remaining one also disappeared 1 month later. Complete left bundle branch block occurred in 2 cases. Complete right bundle branch block occurred in 2 cases and temporary third-degree artrioventricular block in 1 case. All of them were recovered in the week. All patients were demonstrated a great decrease in the their left ventricle end- diastolic pressure ( LVEDP) and left ventricle end-diastolic dimension ( LVEDD) ( P < 0. 05) . Conclusions Transcatheter interventional therapy with domestic occluder devices for VSD with pseudoaneurysm is safe andeffective with few complications. The key is selecting suitable occluders and deploying the occluders in suitable position.