应用偏心型和对称型封堵器介入治疗小儿膜周部室间隔缺损的对比研究

目的比较偏心型封堵器与对称型封堵器介入治疗小儿膜周部室间隔缺损（perimembranous ventricular septal defects,PMVSD）的疗效及并发症。方法回顾分析2002年10月至2007年12月接受介入治疗的PMVSD患儿的临床资料,根据所用器械的不同分为偏心型封堵器组（偏心组）和对称型封堵器组（对称组）,对术前基线资料和术后随访1年内的疗效及并发症进行对比。结果共有509例PMVSD患者入选,其中偏心组266例,对称组243例。两组基线资料中除室间隔缺损（VSD）与主动脉右冠瓣的距离偏心组小于对称组外（3.5±0.7mm比5.2±1.2mm,P=0.01）,其余差异均无统计学意义（P〉0.05）。两组治疗成功率分别为95.5%和96.7%（P=0.98）,术后即刻VSD完全闭合率对称组明显高于偏心组（96.7%比86.8%,P=0.001）,但术后24h及1、3、6、12个月不同随访时间点的完全闭合率两组差异均无统计学意义（均为P〉0.05）。偏心组严重并发症发生率与对称组接近（3.8%比1.6%,P=0.060）,但轻微并发症发生率两组存在差别（56.8%比42.8%,P〈0．001），其中主要是心律失常的发生率偏心组高于对称组（22．6％比13．6％，P〈0．001），而主动脉瓣反流（aortic regurgitation，AR）及三尖瓣反流（tricuspid regurgitation，TR）发生率差异无统计学意义（P〉0．05）。两组均无死亡病例一结论偏心型封堵器和对称型封堵器短、中期疔效相当，严重并发症发生率接近，但轻微并发症中心律失常的发生率偏心封堵器高于对称封堵器，

Transcatbeter closure of perimembranous ventricular septal defects: a comparative study between the asymmetric device and the symmetric device

Objective To compare the efficacy and complications of asymmetric device in closure of perimembranous ventricular septal defects （PMVSD） with those of the symmetric device. Methods A retrospective study was performed in patients with PMVSD in Guangdong cardiovascular insititute from October 2002 to December 2007. The patients were assigned to either the asymmetric group or the symmetric group according to the style of the device used. Baseline clinical date, procedural efficacy and complications were compared after the follow-up of 12 months. Results A total of 509 patients with PMVSD were enrolled in the study, including 266 patients in the group undergoing the asymmetric device and 243 patients in the group undergoing the symmetric device. There were no other differences about baseline clinical data between the two groups （ all P 〉 0. 05 ） except that the distance from VSD to aortic right valve was shorter in the asymmetric group than in the symmetric group（ 3.5 ± 0. 7 mm vs 5.2 ± 1.2ram, P = 0. 01 ）. The procedural success rate was 95.5% for the asymmetric group and 96. 7% for the symmetric group （P =0. 98）. The rate of complete VSD closure at once was 96.7% for the symmetric group and 86. 8% for the asymmetric group （P = 0. 001 ）, however, there was no difference in complete VSD closure rate at 24 h, 1, 3, 6 and 12 month after the occlusion （all P 〉 0. 05）. The major complication rate was 3.8% for the asymmetric group and 1.6% for the symmetric group （ P = 0. 060 ） , but the minor complication rate was higher in the asymmetric group than that in the symmetric group （56. 8% vs 42.8%, P 〈0, 001 ）. There was no death case in both groups. Conclusions The efficacy and incidence of major complication were no significant difference between the asymmetric and the symmetric device within one year follow-up after occlusion, however, the incidence of post-procedural arrhythmia was lower with the symmetric device than with the asymmetric device.