先天性心脏病介入治疗中封堵器回收困难的处理

Experience of solving problem to take back occluder device difficultly in interventional therapy of congenital heart diseases

目的探讨先天性心脏病(先心病)介入治疗中封堵器回收困难的处理方法及安全性,并总结其临床经验。方法26例符合介入治疗条件的先心病患者,室间隔缺损(VSD)16例,房间隔缺损(ASD)4例,动脉导管未闭(PDA)6例,年龄3～16岁,平均(8±2.9)岁,体重13～75kg,平均(23.6±8.2)kg。常规行介入治疗,封堵器打开后因封堵效果不满意,回收封堵器时难以将其收至输送长鞘内,退出体内输送长鞘,选用较大型号的鞘管进行改造后,沿推送杆送至体内封堵器处将其成功回收,而后换用其他型号封堵器进行封堵。结果26例介入治疗中应用常规方法难以回收封堵器的先心病患者,改用较大号自行改造的输送长鞘,均成功将封堵器收回,然后换用其他型号封堵器封堵成功。操作透视时间4.8～13.6min,平均(7.7±2.2)min。封堵即刻及术后3d、1个月、6个月行经胸超声心动图(TTE)、心电图及X线检查,全部患者无残余分流,封堵器位置固定良好,无严重并发症发生。结论采用改造输送长鞘的方法可有效解决先心病介入治疗中封堵器回收困难这一难题,该方法简单、实用、安全及可靠,是处理封堵器回收困难的有效方法。

[Objective] To access the method and its safety of solving the problem to take back the occluder device difficultly in interventional therapy of congenital heart diseases. [Methods] Transcather closures were performed in 26 patients. There were 16 patients with VSD, 4 patients with ASD and 6 patients with PDA, aged 3-16 （8±2.9） years old, weighing 13-75（23.6±8.2） kilogram. It was difficult to take the occluder devicesback into the scabbard because it was not satisfied when it had already been deployed. We took back the occluder devices successfully with a scabbard which was transformed from bigger-size one, and selected different shape occluder devices to closure the defect again. [Results] The occluder device was taken back successfully in 26 patients, and all of those were treated successfully with replaced ocullder devices. The trine of X-ray fluoroscopy was 4.8-13.6（7.7±2.2） roan. All were treated successfully and no severe complication was found, according to the result of TIE, ECG and X-ray fluoroscopy performed immediately and 3 days, 1 month, 6 months after the operations. [Conclusion] It is a troublesome problem to take back the occluder device. It can be resolved with the reformed scabbard. The method is useful, safe, effective and well worth popularization.