儿童膜周部室间隔缺损介入治疗的临床评价

Transcatheter closure of perimembranous ventricular septal defects: a clinical a pplication in children

目的 评价经导管室间隔缺损封堵术介入治疗膜周部室间隔缺损 (VSD)的安全性及临床疗效。方法 2 0 0 2年 11月～ 2 0 0 4年 7月 ,共 5 0例膜周部室间隔缺损的患儿接受了Amplatzer偏心状封堵器经导管介入治疗。男 2 6例 ,女 2 4例 ;平均年龄 (9 1± 4 8)岁 (2～ 17岁 )。其中 1例合并主动脉窦窦瘤 ,2例为外科修补术后残余漏 ,1例合并镜面右位心。经胸超声心动图 (transthoracicechocardiography ,TTE)提示 ,VSD的平均直径 (4 8± 0 9)mm (3～ 7mm )。封堵前右心导管提示 ,肺循环血流量 /体循环血流量 (Qp/Qs)比值平均为 1 32 (1 1～ 2 0 )。 4例中等量左向右分流 ,其余均为少量左向右分流。所有患儿在X线透视及超声监测下通过建立股动静脉轨道 ,经右心系统释放封堵器。并分别于术后 1、3、6、12个月进行超声心动图、心电图、X线胸片随访评价。结果 4 7例患儿封堵器置入成功 ,技术成功率为 94 % ,无死亡病例。术后出现少量残余分流 2例 (<3mm) ,完全性左束支传导阻滞 1例 ,无其他严重并发症发生。所有患儿接受了平均 7个月的随访 (1～ 18个月 ) ,随访中无封堵器移位、脱落以及瓣膜损伤等并发症发生 ,1例残余分流于 6个月随访时消失。超声测量的左室舒张末径 (leftventricleend

Objective To evaluate the s af ety and efficacy of transcatheter closure of perimembranous ventricular septal d efects (TCVSD) in children. Methods From November 2002 t o July 2004, fifty children (26 males and 24 females) with perimembranous(ventri cular septal defect,VSD) underwent an attempt of transcatheter closure using t he amplatzer occluder specially designed for perimembranous VSD. Among the 50 children, one of them was diagnosed with aneurysm of aortic sinus, one with dex trocardia, and two with leakage after the surgical repair of VSD. The mean age of patients was (9.1±4.8)years (ranged from 2 to 17 years). The mean body weight of patients was (33.5±19.7)kg (ranged from 9 to 81 kg). The mean di ameter of VSD measured by transthoracic echocardiography (TTE) was (4.8±0.9)m m (ranged from 3 to 7 mm). The mean rate of quantity of pulmonary flow/quanti y of systemic flow (Qp/Qs) was 1.3±0.3 (ranged from 1.1 to 2.0), the modera te shunt from left to right was found in 4 patients and the small shunt from lef t to right in the rest. Occluder was released through the right heart system. All patients were followed up in 1, 3, 6 and 12 months after procedures of TTE, X-ray and electrocardiography. Results The devices wer e deployed successfully in 47 patients, the rate of success was 94%. There was a tiny (<3 mm) residual shunt in 2 patients after closure. During the follow-u p of 6 months, only one patient had a tiny residual shunt. Complete left bundl e branch block (LBBB) was found in one child who was examined with electrocardio graph 2 weeks later. There was no other severe complication. After 1 to 18 mon ths (mean 7 months) follow-up, all patients demonstrated a great decrease(from 38.5±4.6 mm pre-closure to 35.2±5.1 mm post-closur) in their left vent ricle end-diastolic dimension(LVEDD, P<0.05). Conclusion This study demonstrated that transcatheter closure of membranous VSD us ing occluder would be safe and effective for children, and the results of short -term was satisfied. Further clinical trials are underway to assess the long- term result.