应用国产封堵器闭合室间隔缺损修补术后残余漏

Percutaneous closure of postoperative ventricular septal residual left-to-right shunt with the China made device

目的评价应用国产封堵器治疗室间隔缺损修补术后残余漏的可行性和疗效。方法11例患者,经胸超声心动图测量室间隔缺损术后残余漏直径为3～9mm,平均(5.82±2.09)mm。经股静脉通过6～9F鞘管送入封堵器,在X线透视和超声引导下完成操作。结果左心室造影8例为膜部瘤型,3例为漏斗型。造影显示单出口6例,多出口5例,缺损口直径3～9mm,平均(6.09±1.58)mm。应用封堵器直径(8～12)mm。10例患者应用1个封堵器完全封堵。1例残余漏有4个漏口,应用2个封堵器后仍有少量残余分流。升主动脉造影均无主动脉瓣返流。1例术后第3天发生完全性房室传导阻滞,应用氢化可的松治疗2周后完全恢复。术中X线透视时间8～30min,平均(16.91±4.23)min。术后随访1个月～4年,1例残余分流仍存在。全部患者无血栓栓塞、溶血、感染性心内膜炎,无封堵器移位,无主动脉瓣反流等并发症。结论经导管封堵治疗室间隔缺损修补术后残余漏疗效可靠,操作安全。

Objective To evaluate the feasibility and efficacy of percutaneous transcatheter closure of residual ventricular septal defect （VSD）after surgical closure using China made-nitinol VSD device. Methods Transcatheter closure was attempted in 11 patients （5 males, 6 females）with a residual VSD following surgical closure. The mean residual VSD narrowest diameter was（5.82 ± 2.09） mm （range from 3 to 9 mm）by echocardiography. A 6 F - 9 F delivery sheath was advanced across the residual VSD over a guidewire from femoral vein to deploy the occluder under guidance of left ventriculography and transthoracic echocardiography. Results The left ventriculography showed membranous part aneurism-like residual VSD in 8 patients and funnel type in 3 cases. There were multiple outlet in 5 cases and one outlets in 6 cases, with mean residual VSD narrowest diameter of （6.09 ± 1.58） mm （range from 3 to 9 mm）measured by left ventriculography. The diameter of occluder was（9.18 ± 2.79） mm （range from 8 to 12 mm）. Complete closure of the defect was obtained in 10 cases, and another small residual shunt still remained in one case who had four outlets been treated by 2 occluders. No aortic valvular regurgitation occured＇in all patients except 1 patient presented complete atriovenvencular block within 3 days after the procedure and recovered 2 weeks later with intravenous steroids therapy; and no other complications occured. The fluoroscopy time was （16.91 ± 4.23 ） min （range from 8 to 30 min）. During follow-up from 1 m - 4 y, only 1 case showed residual shunt, and the other had no episodes of endocarditis, thromboembolism, hemolysis, infectious endocarditis, displacement of the occluder and aortic valvular regurgitation. Conclusion Transcatheter closure of postoperative ventricular septal residual left-to-right shunt with China made-nitinol occluder is safe and effective. （J Intervent Radiol, 2007, 16： 516-519）