室间隔缺损膜部瘤的造影分型及介入治疗方法学研究

Angiographic classification of ventricular septal defect with aneurysm and study on its interventional therapeutic methodology

目的 结合介入治疗实践对室间隔缺损 (VSD)伴膜部瘤形成进行造影分型 ,并对不同类型膜部瘤的介入封堵方法进行探讨。方法 2 0 0 2年 11月至 2 0 0 3年 11月 ,采用新型Amplatzer膜部室间隔缺损封堵器对 32例合并膜部瘤的膜周部VSD行封堵治疗 ,平均年龄 19岁 (3～ 4 8岁 )。封堵术前常规行左室造影 ,在经胸超声心动图 (TTE)及透视监测下通过建立股动静脉轨道、经右心系统释放封堵器 ,并于术后 1、3、6、12个月随访复查胸片、超声心动图、心电图。结果 根据左室造影的不同形态 ,将VSD膜部瘤分为漏斗型、囊袋型、菜花型、弯管型 4种类型。 32例VSD合并膜部瘤患者中 ,30例成功行VSD封堵术 ,技术成功率 94 %。其中 3例采用封堵瘤体法 ,9例采用封堵右室面破口法 ,18例采用封堵左室面破口法。术后即刻发生少量残余分流 4例 ,其中 2例 3个月随访时消失。 1例术后 2周出现完全性左束支传导阻滞 ,但无心肌受损表现 ,余无其他严重并发症发生。左室舒张末径(LVEDD)由术前的 (47 4± 7 1)mm缩小为术后的 (45 1± 7 1)mm ,缩小明显 (t =3 83,P =0 0 0 2 )。结论 应用新型Amplatzer膜部VSD封堵器治疗VSD膜部瘤是安全有效的 ,VSD膜部瘤的介入治疗需要根据膜部瘤的位置、形态、破口大小、数目等情况采用不同的封堵?

Objective To evaluate the feasibility and efficacy of transcatheter closure of perimembranous ventricular septal defects (VSD) associated ventricular septal aneurysm using the new Amplatzer membranous VSD occluder, and to discuss the methodology.Methods From November, 2002 to November, 2003, thirty-two patients (15 males, 17 females) with perimembranous VSD associated ventricular septal aneurysm underwent the attempt of catheter closure using a new device specially designed for the membranous septum.The mean age of the patients was (19.3±10.5) years (ranged from 3 to 48 years), and the mean weight of the patients was (49.8±21.4) kg (ranged from 16 to 85 kg).All patients underwent left ventriculography before catheter closure, and the closure was monitored under the transthoracic echocardiography (TTE) and fluoroscopy guidance.The left ventriculography and echocardiography were repeated to assess the efficacy immediately after the closure, and continuous electrocardiograph monitoring lasted for 3 days post-procedure.All patients underwent 1, 3, 6, and 12 months follow-up after the procedures. Results The ventricular septal aneurysm can be classified into four types according to its angiographic appearance, including the “funnel” type, the “sack” type, the “cauliflower” type, and the “siphon” type.The devices were deployed successfully in 30 patients with a tiny (<3 mm) residual shunt in four patients.Complete left bundle branch block (LBBB) was found by electrocardiograph in one patient two weeks after closure, and there were no other severe complications.All patients were demonstrated a great decrease in their left ventricle end-diastolic pressure (LVEDP) and left ventricle end-diastolic dimension(LVEDD)(P<0.05). Conclusion Transcatheter closure of perimembranous VSD associated ventricular septal aneurysm using this new occluder is safe and effective.It is necessary to choose appropriate technique of closure according to the shape, size, and conditions of ventricular septal aneurysm during the interventional procedure.