偏心型封堵器介入治疗嵴内型室间隔缺损临床应用及中期疗效

目的 探讨国产偏心型封堵器介入治疗嵴内型室间隔缺损(VSD)的安全性及中期疗效.方法 2005年1月至2008年7月采用国产偏心型封堵器对26例嵴内型VSD患者行介入治疗.经胸超声心动图提示VSD破口直径3～9mm,平均(4.7±4.5)mm.距肺动脉瓣>2mm,距主动脉瓣>1 mm,并分别于术后1周、1个月、3个月、6个月及12个月进行随访.结果 26例患者中21例封堵成功,5例失败,成功率为80.8%.术后即刻左室造影示少量残余分流2例,微量残余分流3例,均在术后1 d至3个月消失,术后即刻新发完全性左束支传导阻滞(LBBB)1例,余无其他严重并发症发生.封堵术后1周左房内径、左室舒张末期内径即明显缩小(P<0.01),左室收缩末期内径无明显变化,术后1个月及以上各项指标与术后1周比较差异无统计学意义.所有患者均获得随访,随访时间12～48个月.术前合并8例右束支传导阻滞(RBBB),3例LBBB,5例在术后2～14d恢复正常,6例在出院时未恢复正常,包括4例RBBB,2例LBBB.随访1个月时,1例RBBB恢复正常;随访3个月时,1例RBBB恢复正常,余在随访期间持续存在.结论 应用国产偏心型封堵器治疗嵴内型VSD是安全有效的,近中期效果良好,远期疗效尚需进一步临床观察.

Clinical application of eccentric nitinol occluder in transcatheter closure of intracristal ventricular septal defects and its medium-term therapeutic efficacy

Objective To investigate the security and medium-term therapeutic efficacy of domesticmade eccentric nitinol occluder in transcatheter closure of intracristal ventricular septal defects(VSD).Methods From January 2005 to July 2008,transcatheter closure was attempted in 26 patients with intracristal VSD.The diameter of VSD ranged 3 to 9 mm average(4.7 ± 4.5)mm and the distance of VSD to pulmonary valve over 2 mm,to aortic valve over 1 mm.Follow-up was made with transthoracic echocardiography and echocardiography at the 1st week,1st,3rd,6th and 12th months after operation.Results The devices were deployed successfully in 21 patients,the successful rate was 80.8%(21/26).After the operation immediately,left ventricular radiography showed tiny(< 2 mm)residual shunt in 2 patients and trace residual shunt in 3 patients.The residual shunt all disappeared within 1 day to 3 months.Complete left bundle branch block(LBBB)was found on electrocardiogram immediately in 1 patient,and there were no other severe complications.All patients were followed up 12 to 48 months,8 cases combined with right bundle branch block(RBBB),and 3 cases combined with LBBB before operation,5 cases returned to normal after operation 2-14 days,average(7.25 ± 2.46)d,6 cases no returned to normal,included 4 RBBB,2 LBBB.One RBBB returned to normal 1 month after operation,1 RBBB returned to normal 3 months after operation,and the others continued in follow-up period.Conclusion Intracristal VSD may be closed with domestic-made eccentric nitinol occluder safely and effectively,and medium-term effect is good,long-term outcome still needs'more large-scale clinical observation.