经导管封堵主动脉窦瘤破口的初步临床应用

Transcatheter closure of ruptured sinus of valsalva aneurysm using Amplatzer duct occluder

目的探讨经导管封堵主动脉窦瘤破口的可行性及有效性。方法4例患者，年龄7～57岁，均为主动脉右窦窦瘤破裂人右心室，破口直径2～10mm，其中3例为先天性，1例患者为获得性（医源性）。通过建立股动脉．主动脉窦瘤破口．右心室．右心房-股静脉的轨道，在透视和超声的引导下经股静脉顺行性置人合适的动脉导管未闭封堵器（Amplatzer duct occluder，ADO），所选择的ADO直径较破口大1～2mm。结果主动脉窦瘤破口全部封堵成功，仅1例患者术后存在微量残余分流，次日超声证实分流消失。无并发症发生。随访3个月，4例患者症状和体征均消失，超声证实封堵器形态位置良好，无残余分流、栓塞、细菌性心内膜炎、主动脉瓣反流等发生。结论经导管主动脉窦瘤破口封堵术为一种微创、安全和有效的治疗方法，适合于不合并其他需外科处理心血管病变的主动脉窦瘤破裂。其近期疗效良好，中远期疗效有待于进一步观察。

Objective The present study was conducted to investigate the feasibility and efficacy of transcatheter closure of ruptured sinus of Valsalva aneurysm （RSVA）. Methods Four patients （3 females） aged 7-57 years with RSVA （3 congenital RSVA and 1 post-surgery RSVA） were involved in the present study. Two-dimensional and color Doppler echocardiography revealed the ruptures of fight coronary sinus into right ventricle in all cases. The echo estimated size of the defect was 2-10 mm. After the establishment of the arterio-venous wire loop, Amplatzer Duct Occluder （ADO） was successfully deployed by antegrade venous approach in all patients. The diameter of the occluder was chosen to be at least 1 to 2 mm larger than defect. Results The defects were successfully occluded without any complications. On the follow-up 3 months after operation, there was no device embolization, infective endocarditis and aortic regurgitation. Conclusion Transcatheter closure is a feasible and effective modality for RSVA without other anomalies.