应用弹簧圈封堵室间隔缺损——附4例报道

Transcatheter coil occluder for closure of ventricular septal defect (A report of 4 cases)

目的观察应用弹簧圈封堵治疗室间隔缺损儿童的可行性和初步疗效.方法4例膜周型室间隔缺损患儿接受经导管应用弹簧圈封堵术.经左室造影明确室间隔缺损形状、大小和周边情况,选择pfm公司的Duct-Occlud弹簧圈及Cook公司的可控弹簧圈予以病变部位的封堵,弹簧圈直径比室间隔缺损直径大1～4 mm.术后定期行心电图、心脏超声及临床检查随访.结果左室造影显示室间隔缺损部位均有假性室隔瘤存在,分流口呈多发或单发,最大分流口直径分别为2.0 mm、2.7 mm、2.5 mm和1.5 mm.3例病例所选pfm弹簧圈均为同一型号,直径和圈数为7-3-6mm和5-3-4圈(远端-中间-近端),另1例选用Cook公司的可控弹簧圈5 × 5,封堵即刻有少量残余分流,24h后消失.随访时间2个月～1年,未发现有封堵器移位需外科干预者,无右房室瓣返流和主动脉瓣关闭不全,也无心律失常、栓塞及心内膜炎等并发症.结论应用弹簧圈封堵部分小的伴有假性室隔瘤的膜部室间隔缺损可获得良好的疗效,且具有操作简便、金属含量少及损伤小,并可用于小婴儿病例.

Objective To explore the indication, methodology and complication of transcatheter coil closure of ventricular septal defect （VSD） in children. Methods Transcatheter closure of perimembranous VSD with coils was performed in 4 cases from 2003 to 2005. The Duct-Occlud （pfm） and detachable coil（Cook） were chosen for embolization depending on the results of the left ventricular angiogram. The coll size was generally about 1 ～ 4 mm larger than the diameter of VSD. Follow up was carried out with echocardiography, ultrasound and clinical examination. Results The defect diameters of the four cases were 2.0 mm, 2.7 mm, 2.5 mm and 1.5 mm respectively. The Duet-Oeclud were successfully implanted in 3 cases of perimembranous VSD with the same type coil （OD[mm]7-3-6, windings 5-3-4） for each. One detachable coil（Cook）（5 × 5） was implanted in the remaining case.All eases had trivial residual shunt immediately after implantation which disappeared 24 hours later. Follow-up for 2 months to one year showed no coil displacement and secondary bacterial arteritis. No tricuspid and aortic regurgitation, no emboli, no endocarditis, and no arrhythmia were found. Conclusions Coil closure of some small VSD with membranate part pseudo-ventricular aneurysm has good efficacy with the advantages of simple operation, less metal content and mini-invasion also applicable for infants. （J lntervent Radiol,2005,14：346-348）