小腰大边封堵器介入治疗室间隔缺损伴膜部瘤形成的评价

Evaluation on Catheterization to Pseudoaneurysm of Perimembranous Ventricular Septal Defect with Thin-Waist-Big-Side Occluder Devices

目的评价应用新型国产小腰大边封堵器介入治疗室间隔缺损（VSD）伴膜部瘤形成的可行性、安全性和疗效,总结其技术难点与治疗策略。方法49例VSD伴膜部瘤形成患者,造影测量VSD左室面入口直径为8~22（13.8±4.9）mm,右室面均有2个或以上出口,最大出口直径为2~14（5.6±3.1）mm。根据膜部瘤大小、形态、位置及膜部瘤组织黏连牢固程度,植入不同类型和型号国产小腰大边封堵器,封堵器直径为4~16（6.8±2.6）mm。封堵后15min重复左心室造影和经胸心脏超声检查（TTE）,观察封堵即刻效果。术后连续心电图（ECG）监护5d,定期行ECG、心脏超声检查（TTE）。结果49例术后15min左心室造影、TTE显示：45例完全封堵,4例术后造影示少量分流（〈3mm）,1个月后超声复查无残余分流。术中并左、右束支传导阻滞分别为3例和2例,均为一过性,1周内恢复。49例室间隔膜部瘤应用国产小腰大边封堵器封堵治疗均获成功。结论经导管采用国产小腰大边封堵器治疗VSD膜部瘤疗效可靠。技术关键是通过对膜部瘤大小、形态、位置及膜部瘤组织黏连牢固程度判断确定封堵部位及合适封堵器。

Objective To evaluate the feasibility, safety and efficacy of interventional therapy for the pseudoaneurysm of perimembranous ventricular septal defect（VSD） with domestic thin- waist- big- side occluder devices and summarize the technique difficulty and clinical strategy. Methods From Mar. 2004 to Sep. 2006,49 patients of VSD with pseudoaneurysm were enrolled in this study. According to the finding of the left ventricular angiography, the mean diameter of the left inlet of VSD was （13.8 ± 4.9） mm（ ranged from 8 to 22 mm）, the mean diameter of the right outlet of VSD was （5.6 ± 3.1 ） mm（ ranged from 2 to 14 mm）. The mean diameter of the occluders was（6.8 ± 2.6 ） mm （ranged from 4 to 16 mm）. Fifteen minutes after the occluder was used, left ventrlcular angiography and transthoracic echocardiography（TTE） were performed again to evaluate the efficacy. After the procedure,continuous electrocardiogram（ECG） monitoring lasted for 5 days in all patients,ECG and TTE were performed 1,3 and 6 months later. Results The finding of the left ventricular angiography and TIE that performed 15 minutes after the procedure showed that 45 cases were completely closured and slightly residual shunts（ 〈 3 mm） was found in other 4 patients. And confirmed by TTE, the residual shunts all completely disappeared in 1 month after the procedure, which was confirmed by TIE. Temperary left bundle branch block was found in 3 cases while temporary right bundle branch block was found in 2 cases, and all of them were recovered in one Week. Without severe complications, all of the 49 patients were treated successfully with domestic thin - waist - big - side occluder devices. And no severe complications were found. Conclusions Transcatheter interventional therapy with domestic thin - waist - big - side occluder devices for VSD with pseudoaneurysm is safe, effective and promi - sing clinically. The key of the procedure is to select suitable occluders and suitable position to plant them according to the size, morphologic characteristics, position and maturity of the pseudoaneurysm.