应用双封堵器封堵治疗复杂膜部瘤型室间隔缺损

目的:探讨应用双封堵器对复杂膜部瘤型室间隔缺损（VSD）进行介入封堵治疗的可行性、有效性和安全性。方法: 12例复杂膜部瘤型VSD患者，左心室造影后常规右股动脉-左心室-VSD-右心室-右股静脉输送轨道，对VSD进行封堵，重复左心室造影，发现存在不能接受的残余分流，遂建立右股动脉-左心室-VSD-右心室-左股静脉输送轨道，应用第2枚封堵器对残余分流进行封堵，左心室、升主动脉造影以及超声心动图检查确认封堵效果良好，释放封堵器。术后1、3、6、12个月复查超声心动图、X线检查和12导联心电图。结果: 12例患者均封堵成功。术毕即刻造影和超声心动图检查示封堵效果良好，无残余分流，各组瓣膜功能良好，无并发症发生。随访期间所有患者杂音消失，超声心动图检查无残余分流，心电图检查均为窦性心律，无房室传导阻滞或束支传导阻滞。结论: 应用双封堵器对复杂膜部瘤型VSD进行封堵治疗是可行的，且具有满意的疗效和安全性。

Double occluders by transcatheter interventional techniques to close complex membranous ventricular septal defect with aneurysm

AIM: To investigate the feasibility,effectiveness and reliability of double occluders by transcatheter interventional techniques in closing complex membranous ventricular septal defect(VSD) with aneurysm.METHODS: Twelve patients suffering from complex membranous VSD with aneurysm underwent transcatheter interventional therapy with double VSD occluders.After left ventriculography,the pathway was established from the right femoral artery to the right femoral vein through the left ventricle,VSD,right ventricle,right atrium and inferior vena cava.The polysheath was inserted from the right femoral vein introduced by the pathway to the left ventricle,and the first occluder was implanted through the polysheath.Left ventriculography was again performed.In case of any unacceptable residual shunt,the pathway was established from the right femoral artery to the left femoral vein and the second occluder was implanted to close the residual shunt using the same procedure.Echocardiography and contrast examination were performed to confirm results.All patients were followed-up with echocardiography,electrocardiogram and X-ray examination at 1,3,6 and 12 months after the catheter procedure.RESULTS: Procedures were successful in all 12 patients.Echocardiography and contrast examination performed immediately after operation showed that the effect was satisfactory with no residual shunt,valvular regurgitation,or other complications.During follow-up,cardiac murmur disappeared in all patients,and no residual shunt or aortic regurgitation was found.All patients had persistent sinus rhythm with no atrioventricular block or bundle branch block.CONCLUSION: Application of double occluders to close complex membranous VSD by interventional procedure is feasible,effective and safe.