应用Amplatzer膜部室缺堵闭器关闭32例儿童膜周室缺临床分析

Thrascatheter closure of perimembranous ventricular septal defect using asymmetric membranous VSD Amplatzer device in 32 children

目的探讨经导管采用新型Amplatzer膜部室缺堵闭器关闭儿童膜周室缺的安全性及可行性.方法 2002年6月至2004年7月32例膜周部室间隔缺损的患儿接受经导管采用Amplatzer膜部室缺堵闭器的介入治疗,年龄3～15(6.10±2.80)岁,体质量12～31(18.90±5.10)kg,所有病例术前检查证实为膜周部室间隔缺损(PVSD),缺损大小4～13(8.91±2.26)mm,分流口大小2.30～7.00 (3.30±1.06)mm,距离主动脉瓣0.50～8.00(4.21±2.10)mm,有假性室隔瘤形成7例(其中2个及以上分流口2例),部分三尖瓣组织附着19例.术后定期行TTE及临床检查随访.结果本组封堵技术成功率100%,堵塞后即刻完全封堵率90.60%,术后6个月完全封堵率96.90%,仅1例存在无血流动力学改变的少许残余分流.除术中有一过性房性、室性早搏、室性心动过速、房室传导阻滞、束支传导阻滞、无1例发生Ⅲ°AVB,栓塞,溶血,封堵器脱落,心内膜炎等并发症,仅2例(6.30%)有轻微主动脉返流,2例有轻度三尖瓣返流,术后病理生理及血流动力学有明显改善,LVDd、LVDs、LA术后明显缩小,MPA流速、MV流速术后明显减慢.随访时间6～22个月.结论经导管采用Amplatzer膜部室缺堵闭器关闭儿童膜周室缺是非常安全、有效可行的非开胸手术方法.长期的安全和有效性有待进一步临床继续随访及累积经验.

Objective To evaluate the safety and efficacy of thrascatheter closure of permembranous ventricular septal defect （PVSD） using asymmetric membranous VSD Amplatzer occluder device （AAOD） in children. Methods From June 2002 to July 2004, thrascatheter closure of PVSD with AAOD was performed in 32 children, aged 3 - 15 years （ average 6. 10±2.80）, weight 12 - 31 kg （ average 8.90 ± 5. 10 ）. All cases were met with criteria for transcatheter closure. The average PVSDs diameter were （ 8.91 ± 2.26 ） mm （ range from 4 - 13 mm）, the cent flows diameter （3.30 ± 1.06） mm （range from 2.30 -7.00 mm）, and the distance of upper rim in PVSDs to aortic valve （4.21 ±2.10） mm（ range from 0.50 -8.00 mm）. Seven patients had aneurysm of membranous septal, with multiple fenestrate aneurysm of membranous septal in 2 cases, Nineteen patients had PVSD adhesive to tricuspid septal valve, The echocardiography and clinical examination were performed in follow-up. Results The successful rate in technique was for 100% in this group. The immediate, six-month complete occlusion rate were 90.60% （29/32）, 96.90% （31/32）. A trivial hemodynamic insignifi- cant shunt remained in 1 case. No complications including hemolysis, device embolization, embolism,Ⅲ° AVB, bacterial arteritis occurred except transient atrial and ventricular premature beats, ventricular tachycardia, A-V block and bundle branch block. Two patients continued to have trace aortic regurgitation. Two patients continued to have mild tricuspid regurgitation~ The hemodynamic significantly improved after thrascatheter clo- sure of PVSD. The median LVDd, LVDs, LA and the velocity of flow MPA, MV decreased. The follow up chihlren was a safe, efficient and feasible non-surgical method. Further clinical trials are underway to assess the long-term safety and resuhs.