室间隔缺损修补术后残余分流自然愈合的彩色多普勒超声心动图观察

Color Doppler Flow Imaging Assessment of Spontaneous Closure of Residual Shunt After Repair of Ventricular Septal Defect

本文报道２例室间隔缺损修补术后残余分流但以后自然愈合的患者，１例室间隔缺损患者于修补术后１０天彩色多普勒超声心动图检查时见残余分流，在术后１２周复查时发现残余分流自然消失。另１例为室间隔缺损合并房间隔缺损患者，术后第２天有较重的血红蛋白尿，彩色多普勒超声心动图检查时发现心室水平及左室与右房间的残余分流而行再次修补术。第二次术后１５天彩色多普勒超声心动图检查时仍存在左室与右房间的残余分流。继续追踪观察于再次术后７周原残余分流消失，自然愈合。室间隔缺损术后可因修补不完善，补片与空间隔间缝线撕裂，或补片与室间隔间存在较窄的缝隙而出现残余分流。较小的残余分流可因补片与室间隔交接处形成血栓、缝线周围纤维化等因素而自然愈合，患者无需进行再治疗。彩色多普勒超声心动图可较敏感地发现室间隔缺损术后残余分流，并可追踪观察残余分流的自然愈合，因而对其预后判断具有重要价值。

The spontaneous closure of residual shunt in 2 patients who. had residual shunt after repair of ventricular septal defect (VSD)were evaluated by color Doppler flow imaging (CDFI). One patient with VSD had evidence of residual shunt at 10 days after repair and no longer showed evidence ofrsial shunt at 12 weeks after repair by CDFI. One patient with VSD and ASD had residual shunts fromleft ventricle to right ventricle and from left ventricle to right atrium at 1 day after repair. This patientunderwent reoperation. There was evidence of residual shunt from left ventricle to right atrium by CDFIat 15 days after reoperation and at 7 weeks after reoperation, the residual shunt from left ventricle to ri hgt atrium was disappear. CDFI is a sensitive technique in detection of residual shunt after repair ofVSD. We investigated the use of CDFI in assessment of residual shunt after surgical repair of VSD andfollowed up the patients with residual shunt. With time, fibrin deposition and thromb will occur,'Thereby closing the leak between patch and native ventricular seprum. Therefore,small residual shuntcould close spontaneously. The reoperation is not needed for the patioents with small residual shunt.