186例先天性心脏病介入封堵治疗

Clinical study oftranscatheter closure of congenital heart disease using occlude device

目的观察介入封堵治疗先天性心脏病的近期临床效果。方法自2004-11～2008-05,采用国产封堵器治疗先天性心脏病186例,其中动脉导管未闭86例,室间隔缺损60例,房间隔缺损40例,年龄3～32岁。封堵前常规做心电图、胸片、心脏彩超,主要用心脏彩超确定封堵病例,在封堵时再做主动脉造影、左室造影,确定动脉导管及室间隔缺损的形状及大小。动脉导管所选的封堵器直径大于实际测量3～6mm,室间隔缺损所选的封堵器直径大于实际测量1～2mm,房间隔缺损所选的封堵器直径大于实际测量4～6mm。术中在透视监测下建立股动脉及股静脉轨道,在左心室释放封堵器前伞,在右心室释放封堵器右伞封堵室间隔缺损,动脉导管未闭的病人不建立轨道,将长导丝从肺动脉放到胸降主动,在主动脉侧释放前伞,在肺动脉侧释放后伞,封堵动脉导管。房间隔缺损封堵时一般将导丝放在右上肺或者左上肺静脉再进入输送鞘管,在左房侧释放前伞,在右房侧释放后伞封堵房间隔缺损。术后常规服用阿司匹林(3mg/kg),疗程半年。术后3、6、12个月随诊复查心脏彩超、心电图、胸透。结果其中有2例室间隔缺损病例,因缺损较大封堵不成功改作手术治疗,其余全部封堵成功。术后6个月显示肺血明显减少,心胸比例由0.60±0.2减少至0.45±0.15(P<0.05)。术后6个月心脏彩超提示左室舒张末径由术前(56.4±6.5)mm缩小为术后(40.5±3.0)mm(P<0.01),术后6个月肺动脉压由术前(90±23)mmHg降低至(20±15)mmHg(P<0.01)。结论用国产封堵器介入封堵治疗先天心脏病创伤小,恢复快,并发症少,适应证选择合适成功率高,但远期效果需进一步随诊。

Objective To observe the effect of transcatheter closureofcongenital heart disease using occlude device.Meathods From November,2004 to March,2008,186 patientswhich suffered from congenital heart disease were occluded with occluder.The kind of congenital heart disease included ventricular septal defect(VSD) 60 cases,atrial septal defect(ASD)40 cases,patent ductus arteriosus(PDA)86 cases.The mean age was 10.5～7.2(3～32 years old).All patients underwent examination of heart coloure echo and ECG,chest x-ray before catheter closure,and the closure was monitored under the transthoracic echo cardiography and fluoroscopy guidance.The left ventriculaography and aortagraphy were repeated to assess the size of PDA or VSD,and assess the efficacy immediately after the closure.The TTE and chest film were performed 3 months,6 months and 12 months after the closure to evaluate its therapeutic effect.Result Two patients which suffered from VSD were failure to closure and change to operation treatment,another patients all were successed closured.LVED from 56.4～6.5 mm before closureing decreased to 40.5～3.0 mm(P<0.01)after closureing.Culsions Transcatheter closure of congenital heart disease using VSD,ASD and PDA occluder is an efficient method.The procedure is simple method with a high success rate.