膜周部室间隔缺损膜部瘤介入治疗方法的探讨

目的回顾性总结伴膜部瘤的室间隔缺损(VSD)介入治疗病例,对如何选择封堵器的型号和安放位置进行分析,以期促进室间隔缺损介入治疗的进一步规范。方法对2004年5月至2005年5月入院治疗的伴膜部瘤形成的室间隔缺损患儿进行造影、超声和介入过程分析。测量膜部瘤的7条径线,并与封堵器型号和封堵位置进行归纳,寻找可能的选择规律。结果35例患儿被纳入研究。VSDs直径为2．7～11．9 mm,平均(6．4±2．6)mm。膜部瘤的破口最大径为1．5～4．1 mm,平均(2．9±0．9)mm。VSDs边缘距主动脉瓣距离为2～7mm,平均(4．3±1．7)mm。32例介入治疗手术成功。封堵器采用双侧对称伞,从4～14 mm不等。封堵器左室盘封堵缺损左室面者29例、封堵膜部瘤破口左侧者3例。结论封堵器左室盘放置位置取决于右室盘能否在右心室侧复型。首选位置是缺损的左心室面。当右室盘不能正常复型时,可选择在膜部瘤破口左侧放置左室盘。封堵器型号选择应根据封堵器安放位置决定。在左心室面释放左室盘,一般选择型号与左室面直径相等或大1～2 mm。在膜部瘤破口左侧释放左室盘时,如果为单破口型,选择同上;如果为多破口型,选择能遮盖相距最远的两破口间距离的最小封堵器。

Interventional approach to the treatment of aneurysms of the perimembranous ventricular septal defects

Objectives To explore applicable protocol for the positioning of ventricular septal defect (VSD) occluder and the selection of the device by retrospective analysis of transcatheter closure approaeh to the aneurysms of the perimembranous VSD.Methods Thirty-five cases of perimembranous VSD with septal aneurysm (19 males and 16 females) from May,2004 to May,2005 were included,with a mean age of 5.3 y and mean weight of 17.6 kg.Their angiographic and ultrasound data,and interventional processes were analyzed.Seven segments of the aneurysms were assessed:the diameter of the defect on the left ventricle,the diameter of the defect on the right ventricle,the thickness of ventricular septum,the distance from the farthest end of the aneurysm to the defect,the diameter of the widest part of the aneurysm and the distance between the two farthest orifices on the aneurysm.Results Sixteen cystiform aneurysms and nineteen tubiform ones were identified with left ventricular angiography.The diameters of the orifices of aneurysms and the diameters of the VSDs ranged from 1.5 mm to 4.1 mm and 2.7 mm to 11.9 mm, separately,with the mean of 2.9 mm and 4.3 mm.From the echocardiography,the distances of the rim of defect to the aortic valve ranged from 2.0 mm to 7.0 mm,with the mean of 4.3 mm.All the interventions were successfully done with symmetrical devices from 4 mm to 14 mm.The left disc of the device was positioned at the defect surface from the left ventricle in 29 cases,and was released at the left side of the orifice in 3 cases.Conclusions The positioning of the left disc is mostly determined by the condition for the correct formation of the right disc in the right ventricle after deploying.Generally the defect surface in the left ventricle is most ideal to release the left disc of the device.If the body of aneurysm was too long for the right disc to restore its configuration,the left disc should be released on the left side of the orifice.The selection of device size is determined by the placement of the left disc.When the left disc is to be released at the defect surface in the left ventricle,the device size should be equal to or 1 to 2 mm larger than the diameter of the defect on the left ventricle.When the left disc is to be deployed on the left side of an orifice,the device size should be equal to or 1 mm larger than the defect diameter on the left ventricle when there is a single orifice.In the case of multiple orifices,the minimal size of the device which can cover all the orifices should be selected.