不同封堵器介入治疗先天性室间隔缺损

Transcatheter closure of perimembranous ventricular septal defect with difference ventricular septal occluders

目的探讨不同封堵器介入治疗膜周部室间隔缺损(PMVSD)的临床疗效。方法应用非对称型封堵器(AVSDO)或对称型封堵器(SVSDO)介入治疗267例次PMVSD病人。结果255例成功接受介入封堵手术,手术技术成功率95.5%(255/267)。120例次接受AVSDO封堵,150例次接受SVSDO封堵(3例病人先后采用不同封堵器接受两次手术)。室间隔缺损(VSD)大小(4·9±2·5)mm,AVSDO大小(7·5±2·7)mm,SVSDO大小(7·8±2·5)mm。AVSDO和SVSDO组的即刻关闭率分别为93·8%和95·1%,并发症发生率分别为22·5%和22·7%(SVSDO组死亡1例),心律失常发生率分别为19·2%和18·0%。2例伴膜部瘤的VSD用AVSDO封堵后出现残余分流,改用SVSDO成功封堵;1例VSD用SVSDO封堵后中度主动脉瓣关闭不全,改用AVSDO后无主动脉返流。结论两种封堵器介入封堵VSD均有良好的临床疗效。心律失常是它们共同的主要并发症,应认真防治。

Objective To evaluate the results of transcatheter closure of perimembranous ventricular septal defect （PMVSD） with difference ventricular septal occluders. Methods Two hundred and sixty-seven patients underwent transcatheter closure of PMVSD using asymmetric ventricular septal occluder （AVSDO） or symmetric ventricular septal occluder （SVSDO）. Results The implantation was successful in 255 patients （95.5%） ,with AVSDO in 120 cases and with SVSDO in 150 cases. The PMVSD diameter was 4. 9±2.5 mm by angiography. The sizes of AVSDO and SVSDO were 7.5 ±2. 7 mm and 7.8±2. 5 mm, respectively. There was no residual shunt either after the closure of PMVSD in 106 patients （93. 8%） using AVSDO or in 135 patients （95.1%） using SVSDO after the elosure of PMVSD. One patient died of cerebral embolism. The arrhythmias happened to 23 patients （19.2%） using AVSDO and to 34 patients （18. 0%） using SVSDO. The moderate residual shunt happened to 2 patients with ventricular septal aneurysm using AVSDO, which disappeared after using SVSDO. The aortic regurgitation happened to one patient using SVSDO, which disappeared after using AVSDO. Conclusion Thanscatheter closure of PMVSD using AVSDO and SVSDO is safe and effective. The arrhythmias is the main complication and attention should be paid to the prevention of it.