国产封堵器介入治疗室间隔缺损伴膜部瘤44例疗效分析

Evaluation of the effectiveness of catheter closure in 44 cases of ventricular septal defects with membranous aneurysm using China-made occluder

目的:探讨国产封堵器经导管介入治疗室间隔缺损伴膜部瘤的临床疗效。方法:对44例室间隔缺损伴膜部瘤患者行国产封堵器介入治疗,术中左心室造影,测量室间隔缺损直径在2·5～12mm,选择腰部直径为4～14mm国产封堵器进行封堵,10分钟后进行左心室造影,观察即刻效果。并且于术前、术后3日、1个月、6个月行经胸超声心动描记术检查,观察左心房内径、左心室舒张末期内径、射血分数、每搏量、短轴缩短率、肺动脉压的变化。结果:44例中42例成功置入封堵器,其中35例采用国产室间隔缺损封堵器,7例采用国产动脉导管未闭封堵器,介入治疗成功率95%(42/44)。另外2例因膜部瘤太大、多出口、距离主动脉瓣近不能完全封堵,转行外科手术治疗。术后10分钟左心室造影,41例完全封堵无分流;1例有残留少量分流,1个月后复查经胸超声心动描记术示残留分流消失。获随访患者所有封堵器位置及形态良好,未影响主动脉瓣及三尖瓣功能。术后3日、1个月及6个月左心房内径、左心室舒张末期内径、每搏量、肺动脉压较术前明显下降?P(0·05)。结论:应用国产封堵器治疗室间隔缺损伴膜部瘤是一种安全、有效的介入治疗方法,动脉导管未闭封堵器在一定条件下可用于封堵室间隔缺损伴膜部瘤。

Objective： To evaluate the effectiveness of catheter closure in ventricular septal defects with membranous aneurysm using China-made occluder. Methods： Transcatheter closure was conducted in 44 patients of ventricular septal defects with membranous aneurysm. The size of ventricttlar septal defects with membranous aneurysm measured by left ventriculography was 2. 5 to 12 mm. Left ventricnlography was performed repeatedly to assess the effect of occlusion at 10 min after the procedure. The waist diameters of the selected device were from 4 to 14 mm. Transthoracic echocardiography was performed to measure left atrial diameter, left ventricular end-diastole diameter, stroke volume, ejection fraction, fraction shortening, pulmonary artery pressure at pre-operation and 3-day, 1 -month, 6-month post-operation. Results： Occluders were implanted successfully in 42 patients. Among them 35 cases used ventricular septal defects occluder and others used patent ductus arterious device. The success rate of intervention was 95% （42/44）. Two patients were referred to surgical operation because of oversize aneurysm. Trivial shunt remained only in 1 case by left ventriculography at 10 min after the procedure but disappeared after 1 month follow up with TTE. The location and the form of the all oecluder were fine in the patients followed up. The function of the aorta petal and tricuspid valve had not been affected. Left atrial diameter, left ventricular end-diastole diameter, stroke volume, pulmonary artery pressure significantly decreased at 3-day, 1-month, and 6-month after operation（ P 〈 0. 05）. Condusion： Transcatheter occlusure of ventricular septal defects with membranous aneurysm using China-made occluder is a safe, efficient method and patent ductus arterious device can be used for occlusion ventricular septal defects with membranous aneurysm for selected patients.