两种封堵器治疗主动脉窦瘤破裂的疗效及安全性

Safety and efficacy of transcatheter occlusion of ruptured sinus of Valsalva aneurysm using two kinds of occluders

目的探讨应用动脉导管未闭（PDA）封堵器和室间隔缺损（VSD）封堵器治疗主动脉窦瘤破裂的疗效和安全性。方法对19例主动脉窦瘤破裂患者，按所用封堵器分为PDA封堵器组和VSD封堵器组，根据升主动脉造影结果，选择比破口直径大2～5mm的PDA封堵器或VSD封堵器进行经导管介入封堵。术后随访观察临床症状、心电图、残余分流、封堵器形态、有无瓣膜反流等情况。结果两组患者年龄、发病时间和术前TTE所示破口直径、主动脉造影示破口直径差异均无统计学意义（P均〉0．05）。19例均经升主动脉造影确诊为主动脉窦瘤破裂，其中15例右冠状动脉窦瘤破裂入右心室，3例为右冠状动脉窦瘤破裂人右心房，1例无冠状动脉窦瘤破裂人右心室；共使用PDA封堵器10枚，VSD封堵器ll枚，成功率分别为60．oo％（6／10）和90．91％（10／11）。术后随访6个月～6年，未发生血栓事件，无瓣膜反流，无心律失常、感染性心内膜炎、心力哀竭及死亡。结论经导管介入治疗主动脉窦瘤破裂安全有效；应用VSD封堵器较PDA封堵器有一定优势。

Objective To investigate the safety and efficacy of transcatheter closure of ruptured sinus of Valsalva aneurysm （RSVA） using occluder of patent ductus arteriosus （PDA） or ventricular septal defect （VSD）. Methods Nineteen patients of RSVA who received interventional therapy were enrolled and divided into PDA occluder group and VSD occluder group. The size of occluder was 2 to 5 mm larger than the narrowest diameter of the opening of aneurysm showing on as- cending aorta angiography. All patients were followed up in term of clinical symptoms, ECG, residual shunt, occluder shape and aortic regurgitation. Results Patients in two groups were nondiscriminatory in age, time of onset and diameter of the opening of aneurysm measured by TTE and aorta angiography （all P〉0.05）. All patients were confirmed by aortog- raphy, which showing rupture of right coronary sinus into the right ventricle in 15 patients, right coronary sinus aneurysm into the right atrium in 3 patients, and noncoronary sinus aneurysm into the right ventricle in 1 patient. PDA occluder was used in 10 patients, while VSD oceluder in 11 patients, and the success rate was 60.00% （6/10） and 90.91% （10/11）, re- spectively. The follow up was performed for 6 months to 6 years, there was no embolization, aortic regurgitation, bacterial endocarditis, arrhythmia, right heart failure nor death. Conclusion Transeatheter occlusion of RSVA is safe and effective. The application of VSD occluder has certain advantages compared with PDA occluder.