应用小腰大边型封堵器治疗膜部瘤室间隔缺损

目的 探讨小腰大边型封堵器在治疗膜部瘤室间隔缺损(VSD)的可行性及安全性.方法 2006年1月至2010年10月在我院行介入治疗的31例膜部瘤VSD患儿(男15例,女16例),年龄2～16(4.52±3.09)岁.在透视及超声监测下采用小腰大边型封堵器封堵膜部瘤VSD,术后即刻行左室造影、升主动脉造影及经胸超声心动图观察封堵疗效.术后24 h和1、3、6个月复查经胸超声心动图、心电图及胸部X线片.结果 所有患儿均封堵成功,技术成功率为100%,置入封堵器直径4～12(6.83±1.95)mm;封堵后15 min左室造影示即刻完全封堵28例,余2例于术后24 h、1例于术后6个月复查超声时分流消失,完全封堵率总计达100%;术后出现左前分支传导阻滞1例,24 h内恢复正常;随访6个月,所有患者均无高度房室传导阻滞、溶血、瓣膜返流、封堵器移位等严重术后并发症;介入封堵术前后经胸超声心动图各指标变化:封堵术后24 h,左心室舒张末内径、左心室舒张末容积均较术前减少(P<0.01),随访期间上述指标均进一步减少(P <0.01);左室短轴缩短率封堵术后24 h较术前减少(P<0.01),随访1个月复查时进一步减少(P<0.01),随访3、6个月时变化不明显(P >0.05);二尖瓣口流速E/A比值封堵术前后无显著变化,随访中变化亦不明显(P>0.05).结论 应用小腰大边型封堵器治疗膜部瘤VSD安全有效,近期疗效好.

Transcatheter closure of perimembranous ventricular septal defect with aneurysm using the thin-waist-big-side occluder

Objective:To evaluate the feasibility and safety of transcatheter closure of perimembranous ventricular septal defects(PmVSD) with aneurysm using the thin-waist-big-side occluder.Methods: Thirty-one patients(15 men and 16 women) underwent transcatheter closure of PmVSD with aneurysm from January 2006 to October 2010 in our department.The mean age of patients was 4.52±3.09 years(rang from 2 to 16).All patients were treated with the thin-waist-big-side occluders under fluoroscopy,angiography and transthoracic echocardiography(TTE),and were followed-up at 24 hours,1 month,3 months and 6 months after the procedures.Results: The devices were implanted successfully in all patients.The mean diameter of the devices was 6.83±1.95 mm(rang from 4 to 12).There was complete closure in 28 patients immediately.3 patients had small residual shunt but all disappeared within follow-up period.Left anterior fascicular block was found in 1 patient and recovered within 24 hours.No other complications,such as advanced atrioventricular conduction block or valve regurgitation,were found in all cases after the procedures.Conclusion: It is effective and safe to closure perimembranous ventricular septal defects(PmVSD) using the thin-waist-big-side occluder,es-pecially for those PmVSDs with aneurysm.