主动脉边缘不足2 mm膜周部室间隔缺损的介入治疗评价

Transcatheter closure of perimembranous ventricular septal defects associated with aortic rims (<2 mm).

目的评价距主动脉瓣2mm以内的膜部室间隔缺损(VSD)经导管封堵治疗的可行性。方法86(男46,女40)例患者,年龄3～48(12±9)岁。经胸超声检测VSD距主动脉右冠瓣0.5～2(平均1.2)mm,VSD直径3～18(7±4)mm。其中22例有轻度肺动脉高压,2例有轻～中度肺动脉高压。19例伴轻度主动脉右冠瓣脱垂。结果左心室造影测量VSD直径为4～18(平均7)mm,VSD距主动脉右冠瓣0.5～2(平均1.2)mm。84例患者封堵成功,2例伴主动脉右冠瓣轻度脱垂封堵后有少～中量主动脉瓣返流而放弃封堵,成功率为98%。所选封堵器大小为5～22(平均8.4)mm。封堵器到位后即刻左心室和升主动脉造影显示,微量残余分流7例,微量主动脉瓣返流5例。3月超声复查有1例微量主动脉瓣返流,均无残余分流。术后发生高度AVB1例,经药物治疗恢复。结论距主动脉瓣2mm以内的膜部VSD可以成功经导管封堵治疗,其远期疗效尚需长期临床观察。

AIM:To evaluate the feasibility of transcatheter closure of perimembranous ventricular septal defects (VSDs) associated with aortic rims (<2 mm) . METHODS:86 patients (male 46,female 40) underwent attempted transcatheter closure of a VSDs at a median age of 12±9 years (range 3.0 to 48.0) . The distance of VSDs to aortic right valve was 0.5~2(average 1.2)mm.Among them 22 cases associated with small pulmonary hypertension,2 cases with small to moderate pulmonary hypertension.19 cases associated with light aortic right valve prolapse. RESULTS: The mean VSD diameter at its left ventricular side was 7 mm (rang 4.0 to 18.0), the distance of VSDs to aortic right valve was 0.5~2(average 1.2)mm. 84 cases were successfully implanted with success implant rate of 98%,2 cases with aortic right valve prolapse was retracted due to small to moderate aortic insuffiency. The mean selected diameter of the occluder was 8.4 mm ( ranged from 5~22 mm ). The left ventricular graphies(LVG) and ascending aortographies showed that 7 cases had a trace residual shunt and 5 cases associated with trace aortic insufficiency immediately after the procedures. All but one cases had no aortic insufficiency and no cases suffered with residual shunt at 3 month follow-up. One cases suffered with temporary advanced atrial ventricular block and returned to normal after medicines treatment. CONCLUSION: Transcatheter closure of perimembranous VSDs associated with aortic rims (<2 mm) is feasible. Long-term follow-up data are still needed to assess long-term safety and efficacy.