左室入路与右侧术式室间隔缺损介入封堵术的对比研究

Comparison of transcatheter closure of ventricular septal defects by left or right route

目的 比较室间隔缺损（VSD）经导管介入封堵术左室入路与右侧术式的临床疗效及安全性。方法 根据超声心动图选择符合介入治疗条件的VSD46例。21例行左室入路术式者符合以下条件：缺损距主动脉瓣距离≥2mm，缺损直径小于12mm。左心室造影结果示VSD直径为2～10（6±4）mm；其余25例行右侧术式封堵，VSD直径为2～12（7±5）mm。左室入路术式封堵者无需建立动静脉轨道，仅将导丝经缺损送达右心室、肺动脉，沿导丝将输送鞘管送至右心室，将封堵器送至缺损部位进行封堵。结果 左室入路封堵成功率为95％（20／21），介入封堵后UPN4例（19％）存在少量残余分流，17例（81％）无分流，1例（5％）三尖瓣极少量返流，无房室传导阻滞发生；右侧术式封堵成功率为92％（23／25），介入封堵后即刻3例（12％）存在少量残余分流，22例（88％）无分流，1例（4％）三尖瓣少量返流，1例（4．0％）术中出现一过性房室传导阻滞。手术时间和X线暴露时间：右侧入路手术时间（72±19）min，X线暴露时间（26±14）min；左室入路手术时间（44±12）min（P〈0．01），X线暴露时间（8±6）min（P〈0．01）。结论 在选择好适应证的条件下，经左室入路介入封堵VSD是安全有效的治疗方法，可明显缩短手术时间和x线暴露时间。

AIM To compare the efficiency and safety of transcatheter closure of ventricular septal defects （VSD） with VSD occluder by left or right route. METHODS We prospectively compared the difference in closure rates, operation times and complication rates in 46 patients with VSD between two interventional methods. Twenty-one cases were treated by left route （group Ⅰ） and 25 patients were treated by routine right route （group Ⅱ）. The VSD diameter in the two group was 6 ±4 （3 - 10）mm and 7 ± 5 （2- 12）mm, respectively. In group Ⅰ, the margin of defect to the aortic valve was more than 2 mm and the diameter of defect was less than 12 mm. In the left route procedure, a wire was advanced to right ventricle through aorta, left ventricle and VSD. The deliver sheath was then advanced to right ventricle along the wire. The VSD occluder was finally advanced to right ventricle and was positioned to the VSD site guided by fluorescence. RESULTS In group Ⅰ and group Ⅱ, the successful closure rate was 95% and 92%, respectively. In group Ⅰ, there was no residual shunt in 17 of the 21 patients （81%） immediately after the procedure, 4 patients （ 19% ） had a trivial shunt that disappeared at the three-month follow up, and 1 patient suffered with light tricuspid regurgitation. In group Ⅱ, 22 of the 25 patients （88%） had immediate closure, 3 patients （12%） had a small shunt immediately after the procedure but disap peared at the three-month follow up,1 patient had light tricuspid insufficiency and another patient had a transient complete atrioventricular block.The operation time was（44±12）vs.（72±19）minutes（P〈0.01）and the fluorescence time was （8±6）vs.（26±14）minutes （P〈0.01） in gourp Ⅰand group Ⅱ,respectively.CONCLUSION Transcatheter closure of VSD from left ventricle route is an effective and safe technique and it shortens both the procedure time and the fluorescence time.