多孔膜部瘤室缺单封堵器封堵的临床观察

目的探讨国产单封堵器对多孔膜部瘤室缺的封堵效果，并进行术后随访，评价其安全性。方法52例多孔膜部瘤室缺患者，经超声心动图（TTE）确诊，治疗均选用国产对称封堵器进行封堵。首先左室左前斜45°-60°，头位20°造影，根据造影室缺大小、形态选择大小合适的封堵器，建立股动静脉轨道。封堵后即刻左室造影，观察有无残余分流。封堵后随访24h，1、3、6个月，1年。随访指标包括心电图、TTE、放射线胸片。结果52例患者51例封堵成功，1例封堵成功后发生腱索断裂。1例因2次封堵器置入导致室缺明显增大，2例转入外科手术（包括腱索断裂1例），1例封堵器置入膜部瘤内。术后即刻造影，26例有少至微量残余分流，其中20例术后24h分流消失，其余4例于1、3．6个月和1年随访中发现分流消失，2例有少量分流；TTE显示封堵器位置良好。所有患者对主动脉瓣、房室瓣无影响，无栓塞、感染性心内膜炎、溶血等发生。术后8例心电图发生不完全性右束支阻滞，随访中5例持续不完全性右束支阻滞，2例完全性右束支传导阻滞，1例持续完全性右束支传导阻滞。术后3-5d内出现交界性逸搏心律3例，经使用肾上腺皮质激素治疗后恢复窦性心律。1例患者在术后第9天发生完全性房室传导阻滞，置入临时起搏器，经肾上腺皮质激素及维生素C治疗，术后第12天恢复窦性心律，仍为左前分支传导阻滞伴完全性右束支传导阻滞。结论不论多孔膜部瘤室间隔缺损距主动脉瓣有无距离均可选择封堵治疗，Qp／Qs〉1．5，最大孔〈10mm患者均为封堵治疗的适应证。经过2个月至3年的随访，疗效确切、安全。

Clinical observations on the transcatheter dosure on VSD of multihole membranous aneurysm with domestic single occluder

Objective To evaluate the efficacy and safety of transcatheter closure on VSD with muhihole membranous aneurysm using single occluder. Methods 52 patients of VSD with muhihole aneurysm were enroUed. The diagnosis was comfirmed by TTE, domestic occluder were selected. First, selected suitable occluder by measuring the defect size by angiography, and left ventricular angiography and TTE were performed postoperation immediately to evaluate the efficacy. ECG and TTE, chest X-ray were performed 1, 3, 6 months and 1 year later. Results 51 in 52 patients were closed successfully. Chordae tendineae broken was found in 1 case. Mild to modate residual shunt in 26 cases were found by angiography postoperation immediately, the shunt in 20 cases disappeared in 24 h later, the shunt in other 6 cases disappeared in 1, 3, 6 months and 1 year later differently. Incomplete right bundle branch block were found in 8 cases, and 5 were found continuely, complete right bundle branch block were found in 2 cases. Ⅲ degree AVB in 1 case was found in 9 days after operation, it disappeared after temporary pace maker supported for 5 days. Conclusion Transcatheter closure on VSD of multihole membranous aneurysm with single occluder is effective and safe whether there is distance from the defect to aortic valve or not, and VDS should be transeathethe closed as long as the Qp/Qs〉1.5, the defect〈10 mm.