膜部瘤型室间隔缺损介入封堵治疗的临床研究

目的通过使用国产室间隔缺损（ventricular septal defect，VSD）封堵器封堵合并膜部瘤的室间隔缺损，总结及探讨如何安全有效地对该类患者进行内科介入封堵治疗。方法选择2010年1月1日至2013年10月31日广州军区广州总医院收治的47例心内科患者，通过超声心动图、左心室造影术等检查明确诊断为膜部瘤型VSD，同时分析缺损位置、VSD两端内外口径大小、膜部瘤破口数目等。47例患者VSD左心室面口内径为（8．8±3．1）mm，右心室面口内径为（6．9±2．9）mm。所有患者均采用深圳先健科技有限公司研制的膜部VSD封堵器。结果44例患者介入封堵成功，成功率93．6％，介入手术时间（53.5±8.3）min，X线曝光时间（22．2±8．3）min，住院时间7～14d，随访3～6个月均无一例出现残余漏或超过轻度的瓣膜反流、传导阻滞等现象。3例因合并多处破口未封堵成功，建议行外科手术治疗。结论应用VSD封堵器治疗膜部瘤型VSD疗效可靠、操作简便、使用安全，长期疗效需进一步随访观察。

Clinic research on intervention therapy for ventricular septal defect complicated with membranous aneurysm

Objectives To summarize and discuss the safety and effectiveness of intervention therapy on the basis of domestic Amplatzer devices for ventricular septal defect （VSD） complicated with membranous aneurysm. Methods A number of 47 patients collected from 1st January 2010 to 31st October 2013 were diagnosed as VSD complicated with membranous aneurysm by echocardiography and left ventricular angiogram. The position, diameter and defect numbers of VSD were analyzed. The mean left ventricular outlet diameter of VSD was （8.8±3.1） ram. The mean right ventricular outlet diameter of VSD was （6.9±2.9） nnn. Amplatzer devices for VSD closure in this study were made by Xianjian Technology （shenzhen） Co., Ltd. Results Totally 44 cases received successful treatment, with a percentage of 93.6%. The operation duration was （53.5±8.3） rain, the exposure duration of X-ray was （22.2±8.3） min and the in-hospital duration ranged from 7 to 14 days. No residual leakage or mild to sever valvular regurgitation, atrioventricular block was reported in 3-6 months＇ follow-up. Three cases complicated with closure failure were suggested to receive surgical treatment. Conclusions Transcatheter closure by Amplatzer devices for VSD complicated with membranous aneurysm is effective, convenient and safe. Further clinical trials are underway to assess the long-term efficacy.