经胸杂交封堵技术治疗小儿肌部室间隔缺损18例

目的总结非体外循环下心内直视杂交封堵（Hybrid）技术治疗小儿肌部室间隔缺损（mVSD）的经验。方法2010年1月至2012年7月，我们共收治18例肌部室间隔缺损患儿，在非体外循环下行心内直视杂交封堵术治疗mVSD。其中男性11例，女性7例，除1例9岁患儿外，其余患儿平均年龄（10．8±6．7）个月（1～17个月），平均体重（7．4±2．2）kg（4．8～11kg）。2例为多发mVSD，男女各1例。手术在食管超声（TEE）下于右心室游离壁表面定位mVSD最佳穿刺位置，经缺损右室面穿刺并通过导引钢丝及鞘管，导入封堵器行mVSD封堵。术后即刻及出院前行经胸超声评估，出院后定期门诊随访。结果平均肌部室问隔缺损（6．6±1．8）mm大小（4—12mm）。术后即刻食管彩超均未提示明显残余分流。无围手术期死亡，无心律失常。术后随访3个月至1年。2例多发肌部室间隔缺损患儿心脏超声显示心尖部存在极小分流，其余无明显残余分流。全组无严重心律失常，心功能良好，封堵器无移位。结论经胸杂交封堵技术治疗小儿肌部室间隔缺损较传统肌部室间隔缺损修补术损伤小，恢复快，操作安全简便，效果好，可避免体外循环，尤其适用于小年龄低体重不能行介入手术的婴幼儿。

Treatment experience of Hybrid Approaches for Eighteen Children with Muscular Ventricular SeptalDefects

Objetive The purpose of this study is to describe our experience in hybrid approaches for the management of muscular ventrieular septal defects （mVSDs） in infants. Methods From Jan 2010 to July 2012, we used hybrid approaches in 18 patients with mVSDs （ ll male and 7 female）. Seventeen of the pa- tients aged 1 to 17 months （ mean, 10.8 months） with a mean weight of 8.9 kg （ 4.8 -11 kg ） , and the oth- er one aged at 9 years old. Two of the patients had multiple mVSDs （ one male and one female） and the other had only one mVSDs. We made an incision and opened the middle and lower 1/3 of the sternum, did purse- string suture. We introduced a guide wire sheath to occlude the mVSDs. All patients did transthoracic echocar- diography before discharge and did follow-up at out - patient department. Results We occlude the biggest mVSDs in two multiple mVSDs patients and each patient used only one oceluder. Mean VSD diameter was 6.6 mm （4 to 12 mm）. Esophageal uhrasonography found no marked residual shunt influencing heart function. No patient died during the procedure. The patients were follow ed up for 3 months to 1 years, during which none of them died. Tiny defect at the apex cord were found in the two multiple mVSDs patients. None of the patients had abnormal cardiac function afterwards. Conclusions Hybrid VSD device placement under direct vision for closure of mVSDs is more feasible and effective procedure with low rate of residual shunts and better cardiac function, which are common complications of traditional surgery, and thus is an ideal option for infant patients especially those with low weight babies.