膜部室间隔缺损介入分类及封堵器选择的探讨

Angiographic Classification of Ventricular Septal Defect and It's Guidance Value in Selecting the Occluder Type

目的:探讨介入治疗室间隔缺损(VSD)的临床分类、封堵器选择和评价该分类方法的可行性、安全性及疗效。方法:采用膜部VSD封堵器介入治疗(VSDO)患者215例(合并膜部瘤的有200例)。按VSD右室侧形态膜部瘤及大小分为Ⅰ、Ⅱ、Ⅲ型。根据左室造影上缺损缘距主动脉右冠瓣距离是否≥2mm将Ⅰ、Ⅱ型VSD再分为a、b型;将Ⅲ型VSD分为A、B型。封堵术后1天、7天、3月、1年时复查超声心动图、心电图。结果:211例患者封堵成功,技术成功率98.14%。Ⅰa型、Ⅱa型、部分Ⅱb型、ⅢA型和部分ⅢB型选用对称型封堵器;Ⅰb型、部分Ⅱb型选择偏心型封堵器;ⅢB型中66.67%选择小腰大边型封堵器。1例Ⅱa型病例早期术中释放封堵器时发生右房室瓣中量返流。1例Ⅱb型患者使用偏心型封堵器封堵后出现主动脉瓣中量返流放弃介入治疗,ⅢB型有2例有中量残余分流放弃治疗。结论:应用膜部VSDO VSD是安全有效的,VSDO的介入治疗根据该分类方法治疗效果良好。

Objective：To explore the angiographic category of membranous ventricular septal defects （VSD）, and evaluate it＇s referential value in selecting specific type of VSD occluder in transcatheter closure operation. Methods：215 patients with membranous VSD were enrolled. All patients underwent left ventriculography before transcatheter closure. According to left ventriculographie feature, the VSD was basically classified into type＂ Ⅰ ＂[ without ventricutar septal aneurysm（VSA）], type＂ Ⅱ＂ （with VSA and the defect was 〈 10 mm）, and type ＂ Ⅲ ＂ （with VSA and the defect ≥ 10 ram）. And accoding to distance from the margin of defect to the aortic right coronary valve （D-AV）, type＂ Ⅰ＂ and type ＂Ⅱ ＂ were classified into suhtype ＂a＂ （D-AV 52 taro） and subtype ＂b＂（ D-AV 〈2 mm）, respectively. According the number of outlets in the right ventricular, type＂Ⅲ＂ was classified into subtype ＂A＂ （single outlet） and subtype ＂ B ＂ （two or more outlets）. After VSD occluding operation, all patients underwent I day and 3 months follow-up indluding ECG and TTE. Results：211 cases succeeded in sealing the defects by transcatheter closure operation, with a 98.14% of achievement ratio. All cases in type＂ Ⅰ a＂, ＂Ⅱ a＂,＂ⅢA＂ and some patients in type ＂ Ⅱb ＂ and ＂Ⅲb＂were successfully occluded by symmetric VSD occluders .All patients in type ＂ Ⅰb＂ and some cases in type ＂Ⅱb＂ were successfully occluded by asymmetric VSD occluders. 66.67% type ⅢB VSDs occlusion operations adopted thin-waist-big-side VSD occluders. I cases of type ＂ Ⅱb ＂ VSD was forced to quit occlusion treatment due to moderate residental shunt. 1 case in type ＂ Ⅱ ＂ occurred tricuspid moderate regurgitation at early operation. 2 patients of type ＂ ⅢB ＂ happened to have moderate remaining distributary. Conclusion：The angiographic classification methods and corresponding principle in selecting various types ofVSD occluder adopted by our study is easy and feasible with a high achievement ratio.