国产封堵器闭合先天性左向右分流型心脏病的疗效分析

Evaluation of transcatheter closure of congenital heart diseases with left-to-right shunt using the domestic-made occluder

目的评价国产封堵器闭合先天性左向右分流型心脏病的临床疗效、安全性。方法左向右分流型先天性心脏病381例,其中ASD164例、PDA107例、膜部VSD110例。在透视和(或)经胸超声心动图(TTE)指引下置入国产封堵器,术后24h和1、3、6、12个月及以后每年分别行TTE、ECG和X线胸片检查以评价治疗效果。结果①107例PDA成功置入封堵器,成功率达100%。随访1-33个月,所有病人健在,未发现残余分流、溶血及感染性心内膜炎等并发症。②164例ASD中162例成功置入封堵器,即刻TTE显示158例(98%)封堵完全,4例(4%)存在微量或少量残余分流;术中封堵器脱落1例。随访1-35个月,所有病人健在;1例随访1年后仍存在少许残余分流,2例术后6个月随访时发现封堵器移位伴少量分流。③110例膜部VSD中109例闭合成功,成功率99%,术中未发生任何并发症,术后即刻造影无残余分流。随访1-26个月,所有病人健在,1例封堵器放置后出现完全性右束支传导阻滞,随访12个月未见恢复。结论应用国产封堵器闭合先天性左向右分流型心脏病,疗效可靠,使用安全。

Objective To evaluate the efficacy and safety of transcatheter closure of congenital heart diseases with left-to-fight shunt using the domestic-made occluder. Methods Third hundred and eighty one patients with congenital heart diseases with left-to-right shunt, including 164 atrial septal defects （ASD）, 107 patent ductus arteriosus （PDA）, 110 perimembranous ventricular septal defects （ VSD）, were enrolled in the study. Confirmed by transthoracic echocardiography （TYE）, the domestic-made occluder was implanted percutaneously. TTE ,ECG and X-ray examination were applied to evaluate efficacy at the time interval of 24 h, 1 month,3 months,6 months, 12 months and yearly after the procedure. Results （1） In 117 PDA group, the narrowest diameter （cardioangiography） were 2.5 - 14-.5 mm with the mean of （7.9 -6.9） mm, the diameter of occluders ranged from 4- 6 mm to 24- 26 mm. All patients were implanted occluders successfully, the success rate of the procedure was 100%. In the following 1 - 33 months, all patients were survival, and no residual shunt, haematolysis, infective endocarditis and other complications. （2） In 164 ASD group, the stretched diameter （TtE） before procedure was 5 - 37 mm with the mean of （ 19.5 ± 5.6 ） mm, the diameter of occluders were 8 - 42 mm with the mean of （24.2 ±5.7） mm. Occluders were implanted in 162 patients successfully, and the success rate of the procedure was 99%. One patient＇S occulder fell in procedure, 158（98% ） had complete immediate closure and 4-（2% ） had trivial residual shunt with TIE after procedure. The follow-up lasted for 1 - 35 months. All patients were survival. One year later, residual shunt occurred in 1 patient . Occluder displace and residual shunt occurred in 2 patients six months after procedure. （3） In 110 VSD group, the narrowest diameter （cardioangiography） were 3.4-11.5 mm with the mean of （ 6.1 ± 2.7 ） ram, the diameter of occulders were 6 - 18 mm with the mean of （ 8.7 ± 1.8） mm. Occluders were implanted in 109 patients successfully. The success rate of the procedure was 99%, no complication occurred during the procedure. No residual shunt took place immediately （cardioangiograph） after the procedure. In the 1 - 26 months follow-up, all patients were survival. One patients suffered from right bundle branch block after procedure, and had no improvement in the following 12 months. Conclusion Transcather closure of congenital heart diseases with left-to-right shunt using domestic-made occluder is safe and effective.