膜周型室间隔缺损经皮导管介入封堵术中建立输送轨道的操作技巧

目的 介绍膜周型室间隔缺损（PmVSD）导管介入封堵术中建立轨道时的一种操作技巧.方法 选择117例PmVSD患儿实施经皮导管介入封堵术,术中应用导丝引导输送鞘管指向左心室心尖部的方式建立输送轨道,观察手术效果及并发症的发生率.结果 全部手术时间22～58 （33.36±8.50） min,X线透视时间（13.02±4.11） min.12岁以下儿童75例采用全麻下实施操作,余患者均采用5％利多卡因局麻下实施.所有病例手术均获得成功,但有25例因术中导丝穿过三尖瓣腱索而重新建立轨道;有16例发生一过性室性心律失常,1例出现窦性心动过缓、窦性停搏,恢复后继续实施操作并获得成功;有2例因封堵器型号不当而更换封堵器.有1例术后出现微量残余分流.术后未出现即刻主动脉瓣反流、新发的三尖瓣反流及溶血者.随访12个月中并未发生封堵器移位、迟发的传导阻滞、主动脉瓣关闭不全、感染性心内膜炎及溶血.结论 应用导丝引导输送鞘管指向左心室心尖部这一改良技术可提升PmVSD导管介入封堵术建立输送轨道时的安全性.

The operating skills about establishing the delivery channel in the transcatheter closure of perimemberanous ventricular septal defect

Objective To introduce the operating skills of establishing the delivery track in the transcatheter closure of perimemberanous ventricular septal defect. Methods A total of 117 patients with perimemberanous ventricular septal defect were undergone catheter occlusion. During the surgeries, we established the delivery track through a improved way that is moving the sheath to the left ventricular apex direction under the guidewire. We observed the surgical effects and the incidence of complications. Results We had to reestablish the delivery track in 25 patients because the guidewire passed through the tricuspid valve chordae. During the surgeries, there were 16 patients with transient ventricular arrhythmia, 1 patient with sinus bradycardia and sinus arrest, but all operations and were continued successfully. Occluders were changed in 2 patients due to improper occluders size. One patient presented trace residual shunt after surgery. There were no with immediate postoperative aortic regurgitation, newly-emerging tricuspid regurgitation and hemolysis. During 12-month postoperative follow-up, there were no occluders displacement, delayed conduction block, aortic regurgitation, infective endocarditis, and hemolysis. Conclusions Moving the sheath to the left ventricular apex direction under the guidewire could improve the safety in establishing the delivering track in transcatheter closure of PmVSD.