室间隔缺损并主动脉瓣脱垂患儿的介入治疗及疗效评价

Intervention Therapy and Efficacy Evaluation of Ventricular Septal Defect with Aortic Valve Prolapse in Children

目的探讨室间隔缺损(VSD)并主动脉瓣脱垂(AVP)介入治疗的安全性和可行性。方法选择2007年5月-2009年4月在本院住院的VSD并轻度AVP患儿43例,均行经皮VSD堵闭术,经胸超声心动图显示VSD位置及内径,左心室造影均显示VSD并AVP,造影显示VSD大小为2.6～8.3 mm。其中19例为嵴内型(又称膜周流出道型),15例为隔瓣后型,9例为膜周部。右冠瓣脱垂27例,无冠瓣脱垂12例,右冠瓣并无冠瓣脱垂4例,并局限主动脉瓣返流8例。术后进行超声心动图、心电图的随访观察。结果36例成功封堵VSD,封堵成功率83.7%;7例试封堵后再次行左心室及主动脉造影,显示主动脉瓣下有明显切迹,瓣膜返流加重而放弃堵闭术,择期进行外科手术。采用偏心封堵器15例(5～12 mm),大边小腰封堵器(4～14 mm)16例,普通对称型封堵器(5～10 mm)5例。术后即刻造影有微量残余分流4例,原有的主动脉瓣返流无明显加重;随诊3～18个月,超声心动图示4例残余分流,分别在术后3～6个月消失,主动脉瓣局限返流无进一步增加,其中6例返流减少,未出现三尖瓣狭窄、主动脉瓣狭窄及主动脉瓣穿孔,心电图示无Ⅲ度房室传导阻滞等严重心律失常。结论VSD并AVP及轻度主动脉瓣返流患儿,选用合适的封堵器进行介入治疗是安全、可行的,近中期疗效满意,远期疗效评价需进一步密切随访。

Objective To evaluate the feasibility about the transcatheter closure of perimembranous ventricular septal defects （PMVSDs） and intracristal VSD with aortic valve prolapse（AVP）. Methods From May. 2007 to Apr. 2009,43 children aged 3 to 16 years,weight 13.0 to 43.5 kg underwent an attempt of transcatheter interventional occlusion of VSD. Twenty - four cases were PMVSDs and 19 cases were intracristal VSD. Before the procedure,the transthoracic echocardiography and left ventricular angiography showed that all cases were complicated with AVP. The diameter of the defect ranged from 2.6 - 8.3 mm. And 8 cases showed slight aortic regurgitation. The devices used were the domestic occluders. A follow - up study of echocardiography and electrocardiogram was performed after the procedure. Results The procedure was successful in 36 patients （83.7%）. The iuterventional therapy was given up in 7 cases,because of a visible incisure at the lower margin of the aortic valve ＇after the attempt to implant an occluder. The device diameter ranged from 4 - 14 ram. Asymmetrical devices were used in 15 patients,large left disc devices （diameter ranged 4 - 14 mm） in 16 patients, and symmetrical devices（ diameter ranged 5 - 10 mm） in 5 patients. A trivial resi-dual shunt was seen at 24 hours in 4 patients and disappeared in the 3 to 6 month follow up. The original aortic regurgitations were not aggravated but decreased in 6 patients. Neither tricuspid nor aortic valve stenosis was observed by echocardiogram, nor was aortic valve perforation. No complete atrial ventricular block and other complications occurred. Conclusions In properly selected cases of perimembranous and intracristal VSD,the transcatheter closure is safe and feasible by using appropriate occluders. Further studies are required to evaluate its long term results by followed up.