应用室间隔封堵器介入治疗膜部室间隔缺损疗效评价

Therapeutic effect of transcatheter closure of perimembrane ventricular septal defect using VSD occludes device

目的：应用室间隔缺损封堵器治疗膜部室间隔缺损（pefimexnbrane venticular septal defect，PMVSD）并对近期疗效进行观察。方法：2003年11月-2004年12月，采用室间隔缺损封堵器对23例膜周部VSD行封堵治疗，平均年龄（18．6±5．4）岁（4—34岁）。封堵术前常规行左室造影，在经胸超声心动图（TTE）及透视监测下通过建立股动静脉轨道、经右心系统释放封堵器。并于术后1、3个月随访复查胸片、超声心动图、心电图。结果：手术技术成功率100％，术中未发生任何重要并发症。术后即刻发生少量残余分流2例，其中1例1个月是访。X线检查全部显示肺血减少心胸比例不同程度缩小。左室舒张末径（LVEDD）由术前的（45．1±8．4）mm缩小为术后的（42．9±8．9）mm，缩小明显（t=3．94，P=0．002）。结论：经导管置入室间隔缺损封堵器治疗PMVSD是一种成功率高、近期疗效可靠的介入方法，其远期疗效需进一步观察。

Objective： To evaluate the therapeutic effect of transcatheter closure of perimembrane ventricular septal defect （PMVSD） using VSD occludes device. Methods： From November , 2003 to December, 2004, 23 patients （males, females）with perimembranous VSD and a mean age of 18.6 ± 5.4 years （ ranging from 4 to 34 years）, were each treated with VSD occludes device. All patients underwent left ventriculography before catheter closure, and the closure was monitorded under the transthoracic echocardiography （TIE） and fluoroscopy guidance. The left ventriculography and echocardiography were repeated to assess the efficacy immediately after the closure. The TIE and chest film were performed 24 hours, 1 and 3 months after the procedure to evaluate its therapeutic effect. All patients underwent 1,3, and 12months follow -up after the procedures. Results： The success rate was 100% and no complications occured during the procedure. X - ray examination showed that both pulmnary vascularity and heart size were improved. The devices were deployed successfully in 21 patients with a tiny residual shunt in two patients , one of those residual shunt disappeared after 1 month. All patients were demonstrated a great decrease in their left ventricle end - diastolic dimension （LVEDD） （ P 〈 0.05 ）. Conclusions： Transcatheter closure of perimembrane ventricular septal defect using VSD occludes device is an efficient method for patients with PMVSD. The operation is simple with a high success rate of placement and a hood occlusion effect.