对称型室间隔封堵器在先天性膜周部室间隔缺损介入治疗的应用

Transcatheter closure of perimembranous ventricular septal defect with symmetric ventricular septal occluder

目的探讨对称型封堵器(SVSO)介入治疗膜周部室间隔缺损(PMVSD)的临床疗效。方法应用SVSO介入治疗63例PMVSD患者。结果手术技术成功率93.0%(58/63)。PMVSD直径5.1±1.9mm,PMVSD距主动脉瓣2.7±1.0mm,SVSO直径7.2±2.1mm。即刻封闭率94.8%。心律失常发生率23.8%(15/63例),心肌损伤2例,封堵器脱落1例,术后新发生的主动脉瓣关闭不全1例,右心室流出道梗阻1例。平均随访7.4±2.7个月,无残余分流、封堵器移位或破损及感染性心内膜炎等发生。结论应用SVSO介入治疗PMVSD疗效好、安全性高,但要高度重视其可能发生的并发症,尤其是要做好心律失常的防治。

Objective To evaluate the effect of transcatheter closure of perimembranous ventricular septal defect （PMVSD） with symmetric ventricular septal occluder （SVSO）. Methods Sixty-three patients with UCG confirmed PMVSD underwent transcatheter closure with SVSO. Results The implantation was successful in 58 patients （93.0%）. The mean PMVSD diameter was 5.1 ± 1.9 mm by angiography. The distance from the aortic valve to the rim of PMVSD was 2.7 ± 1.0 mm and the mean size of SVSO was 7.2±2.1 mm. There was no residual shunt in 55 patients （94.8%） right after the deployment of SVSO. Arrhythmia was recorded in 15 patients （23.8 % ） during or after the procedure. New aortic regurgitation was observed in one patient after the implantation SVSO. Two patients developed myocardium injury and one patient developed obstruction of right ventricular outflow tract. Dislocation of the device was found in one patient. During the follow-up of 3 to 12 （means 7.4 ＋ 2.7） months, no residual shunt, displacement or rupture of divices and endocarditis happened. Conclusion Transcatheter closure of PMVSD using SVSO is safe and effective, meanwhite attention should be paid to the complications such as arrhythmias.