介入法治疗室间隔缺损修补术后残余漏

Transcatheter closure of residual fistula after surgery repair of ventricular septal defect

目的评价室间隔缺损(VSD)修补术后经导管封堵治疗的临床效果。方法9(男4,女5)例患者,年龄5～40岁。其中膜部VSD术后7例,法洛四联症(TOF)术后2例。经胸超声心动图测量VSD术后残余漏直径为3～12mm。有7例为1个残余漏口,2例有2个残余漏口。结果左心室造影5例膜部瘤的左室面直径14～28mm,漏口均在膜部瘤的出口。其中3例残余漏有1个孔,其大小分别为4、6和7mm,用6、9和10mmVSD封堵器。2例有2个孔,其大小分别为3、6mm和9、7mm,两孔之间距离分别为8和10mm,均放置两个封堵器,1例为5和9mmVSD封堵器,1例为14mmVSD封堵器和12/14mm动脉导管未闭封堵器。2例膜部VSD,其漏口直径分别为3和10mm,用5和14mm封堵器。2例TOF术后并发VSD残余漏,其漏口直径分别为9和14mm,用12和18mm封堵器。术后即刻左心室造影8例无残余分流,1例两个封堵器的患者有少量残余分流。升主动脉造影全部患者无主动脉瓣返流。随访1～6月复查超声心动图,有残余分流的1例在3月消失,全部患者封堵器无移位,无主动脉瓣返流。结论经导管封堵治疗室间隔缺损修补术后残余漏是一项操作安全、疗效可靠的治疗方法。

AIM: To evaluate the effect of transcatheter closure of residual fistula after surgery repair of ventricular septal defect (VSD). METHODS: 9 (4 male, 5 female) patients, aged from 5 to 40, were investigated. In which 7 cases were post-surgery of membranous VSD, 2 cases were post-surgery of tetralogy of Fallot (TOF). The diameter of residual fistula measured by transthoracic echocardiography was from 3 to 12 mm. 7 cases with only 1 residual fistula, and another 2 cases with 2 residual fistulae. RESULTS: In 5 cases, the diameter of membranous aneurysm of left ventricular measured by left ventriculography was from 14 to 28 mm, the fistulae were all in the exit of membranous aneurysm. Among them, one fistula was found in 3 cases, and the size of fistula was 4,6,and 7mm, respectively, and the implanted occluder was 6, 9, and 10 mm VSD occluder, respectively; 2-fistula was found in 2 cases, and the size of fistula was 3/6 mm and 9/7 mm, respectively, the distance between the 2-fistula was 8 and 10 mm, respectively, were all implanted with 2 occluders (1 with 5/9 mm VSD occluders, another with 14 mm VSD occluder and 12/14 mm PDA occluder).Another 2 membranous VSD, the diameter of fistula was 3 and 10 mm, respectively, the implanted occluder was 5 and 14 mm, respectively. 2 TOF residual fistula, the diameter of fistula was 9 and 14 mm, respectively, and the implanted occluder was 12 and 18 mm, respectively. Immediately after occlusion, by left ventriculography, no residual shunt was found in 8 cases, small residual shunt was found in 1 case implanted with 2 occluders. None was found aorta regurgitation by ascending aorta angiography. During 1~6 months follow-up, examined by echocardiography, 1 case residual shunt was disappeared after 3 month of occlusion; none was found occluder shift and aorta regurgitation. CONCLUSION: Transcatheter closure of residual fistula after surgery repair of ventricular septal defect is a safe, with reliable results therapy.