室间隔缺损介入治疗的并发症防治

Prevention and Management of Complications Induced by Interventional Therapy for Ventricular Septal Defect

目的探讨小儿室间隔缺损(VSD)经导管介入治疗的并发症原因及其防治。方法选择VSD患儿362例。男152例,女210例;年龄2-14(9.3±5.8)岁;体质量11.0-65.0(20.5±11.8)kg。并动脉导管未闭(PDA)16例,并房间隔缺损(ASD)8例,并肺动脉瓣狭窄(PS)2例,常规行介入手术治疗。结果患儿术前均经胸超声检测VSD为2.7-13.0 mm,平均6.5 mm;术中心室造影测量VSD为2.5-14.0 mm,平均6.2 mm;345/362例(96.2%)封堵成功。所选封堵器为4.0-16.0 mm,平均8.6mm。发生心脏并发症33例,血管并发症13例,其他并发症4例,包括Ⅲ度房室传导阻滞5例,Ⅱ度房室传导阻滞3例,交界区性心律4例,室性期前收缩5例,完全性左束支传导阻滞6例,完全性右束支传导阻滞4例,主动脉瓣关闭不全、残余分流各3例,基底核区脑梗死1例,股动脉假性动脉瘤、股动静脉瘘各5例,股动脉血栓3例,溶血、血尿1例,交换导丝断裂、猪尾导管断裂各1例。结论经导管介入治疗小儿VSD操作简单、成功率高、相对安全、近期临床疗效好,但应进一步加强心律失常、血栓等并发症的防治。

Objective To approach the incidence,cause, treatment and prevention of complications developing during or after interventional therapy for ventricular septal defeet（VSD）in children. Methods Interventional procedures of VSD were performed in 362 patients（152 boys and 210 girls） ;aged 2 to 14 years,mean age （9.3±5.8） years and weighted 11.0 - 65.0 kg,mean weight （20.5 ±11.8 ） kg at our hospital,which were retrospectively analyzed. All the subjects were diagnosed by clinical data, X - ray, electrocardiogram and echocardiography,26 patients with multiple lesions, included 16 patients with ductus arteriosus（PDA）, 8 patients with atrial septal defeet（ASD）and 2 patients with pulmonary stenosis（PS）. Results VSD diameter was 2.7 - 13.0 mm by ecbocardiography,2.5 - 14.0 mm measured by left ventricular angiography and the diameter of occluder selected was （6.2±4.1 ）mm. The successful rate was 96.2 %. Cardiac complications developed in 33 cases, vascular complications in 13 eases and others in 4 eases. Conclusions The operation of VSD with domestic occluder devices is simple and safety. It is important to prevent the cardiac and vascular complications.