导管介入或镶嵌治疗心尖部肌部室间隔缺损

目的探讨经导管介入或镶嵌治疗心尖部肌部室间隔缺损的治疗方法、疗效及随诊情况。方法选择2006年1月至2011年12月在广东省人民医院术前诊断为心尖部肌部室间隔缺损的患儿27例为研究对象,其中男18例,女9例,年龄1个月～13岁,中位年龄4.5岁。患儿分别经导管介入及镶嵌治疗,其中镶嵌治疗3例,经导管介入治疗24例。结果介入封堵组除1例因缺损小,未行治疗外,其他23例均介入治疗成功。室间隔缺损直径为(4.94±1.08)mm,选择6～10 mm肌部缺损封堵器,输送长鞘为6～9 F。镶嵌治疗组3例均成功治疗。随诊时间平均25个月。介入封堵组术后随诊有5例少量残余分流,2例中度三尖瓣反流。结论经导管介入治疗心尖部肌部室间隔缺损的疗效确切,应尽量减少三尖瓣的并发症。年龄小于1岁及体质量小于5 kg的婴儿,可考虑采用镶嵌治疗方法。

Apical muscular ventricular septal defects treated by transcatheter intervention or hybrid procedure

Objectives To explore the methods, efficacy and follow-ups of transcatheter intervention or hybrid procedure in treating apical muscular ventricular septal defects. Methods A Total of 27 patients （18 males and 9 females） diagnosed as apical muscular ventricular septal defects by echocardiography in Guangdong General Hospital from January 2006 to December 2011, aged 1 month to 13 years （median age 4.5 years）, underwent transcatheter intervention or hybrid procedure for apical muscular ventricular septal defects were selected in this study. Three patients received hybrid procedure, and 24 received transcatheter intervention. Results Twenty-three patients were successfully treated by transcatheter intervention, except 1 case whose defect was considered as too small and received no intervention. The stretched diameter of the defect was （4.94±1.08） ram, and 6 to 10 mm homemade ventricular septal defect occlude was selected as the device. A 6-9 French sheath was used to deliver the occluder. Three patients were successfully treated by hybrid procedure. The mean follow-up duration was 25 months. Of the 23 patients received transcatheter intervention, mild residual shunting persisted in 5 cases and moderate tricuspid regurgitation in 2 cases. Conclusions It is effective to close apical muscular ventricular septal defect by transcatheter intervention, but tricuspid valve complications should be reduced. In patients weighted less than 5 kg and aged less than 1 year, hybrid procedure was another considerable choice.