经导管封堵治疗室间隔缺损的临床应用

Transcatheter closure of ventricular septal defects

目的：探讨经导管途径治疗室间隔缺损（VSD）的可行性及近期疗效。方法：2003年12月至2005年3月采用VSD封堵器对13例（男8例，女5例）VSD（4例合并膜部瘤）患者进行封堵治疗。患者年龄4—35岁，平均（15．2±10．7）岁，胸部超声提示VSD的直径为4—12mm，平均（5．4±1．2）mm。在X线透视及超声监视下通过建立轨道、经右心系统释放封堵器，并分别于术后1、3和6个月进行随访。结果：12例患者封堵器置入成功，成功率为92％。术后即刻超声及造影显示完全封堵11例，微量残余分流1例，10min后造影显示分流消失。术后出现完全性右束支传导阻滞1例，但无心肌受损表现，余无其他严重并发症。1例嵴内型VSD由于距主动脉较近，封堵未成功。结论：采用经导管途径治疗VSD是安全有效的、近期效果良好，但远期效果有待更大规模的临床观察。

Objective ： To evaluate the feasibility and effect of transcatheter closure of ventricular septal defects （VSD） using the VSD occluder. Methods ： From December 2003 to March 2005, 13 VSD patients, 8 males and 5 females, ranging in age from 4 to 35 （ 15.2 ± 10.7 ） years, underwent catheter closure using the VSD occluder. Tthe mean diameter of the VSD obtained by transthoracic echocardiography was 4 -12 （5.4 ±1.2） mm. Transcatheter closure was performed under transthoracic echocardiographic guidance after left ventriculography. All patients were followed up 1, 3 and 6 months after the procedures. Results： The devices were successfully placed in 12 of the patients and complete closure achieved in 11. Trace residual shunt was observed in 1 patient but disappeared within 10 minutes. No severe complications were noted except 1 case of complete right bundle branch block revealed by electrocardiography. Conclusion ： Transcatheter closure of VSD by the VSD occluder is a safe and effective procedure, with good immediate results. Further clinical trials are under way to assess its longterm effect.