应用国产封堵器治疗嵴内型室间隔缺损与膜周型室间隔缺损的对比研究

目的:探讨国产封堵器介入治疗室间隔缺损(VSD)的适应证,并比较其治疗嵴内型VSD和膜周型VSD的差别。方法:VSD患者共32例,其中嵴内型VSD组6例,膜周型VSD组26例,比较2组的手术步骤及方法,总的手术时间及建轨时间,封堵成功率,术后残余分流及并发症发生情况。结果:嵴内型组总手术时间120~170min,平均147min,其中建立轨道时间28~87min,平均47min;膜周型组总手术时间70~280min,平均105min,其中建立轨道时间15~110min,平均34min。2组比较,嵴内型组的总手术时间及建立轨道时间均明显长于膜周型组(均P<0.01);两者封堵成功率均为92%以上,差异无统计学意义(P>0.05);2组患者术中均出现一过性心律失常,改变导管位置或撤离导管后均立即消失,膜周型组1例患者术后第4天发生脑栓塞,经脑血管介入溶栓治疗症状缓解出院,2例术后12h内发生完全性左束支传导阻滞,均经激素治疗后3d内恢复正常。术后24h复查超声心动图,嵴内型组无残余分流,膜周型组1例存在少量残余分流。结论:应用国产封堵器介入治疗嵴内型VSD能达到和膜周型VSD封堵同样的疗效,另外,应用国产封堵器除其明显的价格优势外,对于嵴内型VSD,国产偏心型封堵器较进口Amplatzer封堵伞更具优势。

A comparison on the effect of curing perimembranous ventricular septal defects and intracristal ventricular septal defects by transcatheter occlusion with domestic occluder

Objective:To compare the effect of curing perimembranous ventricular septal defects and intracristal ventricular septal defects by transcatheter occlusion using domestic occluder.Method:Data of 32 patients with ventricuar septal defect were analyzed. Among of them,6 patients suffered from intracristal ventricular septal defects, and 26 from perimembranous ventricular septal. Result:The operation itself and the selection of occluders of the intracristal ventricular septal defects group differ greatly from that of the perimembranous ventricular septal defects group: the whole procedure time of intracristal ventricular septal defects was 120-170 min(mean 147 min)and the time of establishing gath was 28-87 min(mean 47 min); the whole procedure time of perimembranous ventricular septal was 70-280 min(mean 105 min) and time of establishing gath was 15-110 min(mean 34 min); the rate of success of both groups are more than 92% .Conclusion:Transcatheter occlusion of intracristal ventricular septal defects by domestic occluder has the same effect as perimembranous ventricular septal defects.