介入封堵治疗先天性心脏病97例临床分析

Interventional therapy for congenital heart disease with occluder

目的探讨应用封堵器介入治疗先天性心脏病的方法并评价其效果、安全性。方法超声心动图确诊的32例动脉导管未闭（PDA）、31例房间隔缺损患者,34例室间隔缺损（VSD）患者,均在X线透视及造影和经胸超声心动图（TTE）指引下经导管置入封堵器,术后24h、1、3、6、12个月分别行TTE、ECG和X线胸片检查评价治疗效果。结果32例PDA经造影或TTE测量PDA最窄处直径为2.3-8.6mm,平均（4.3±1.5）min,选择封堵器直径6-14mm,平均（8.5±1.8）min;31例ASD经TTE或导管测量ASD直径16-32mm,平均（21±2.1）min,选择封堵器直径18-35mm,平均（26±1.8）min;34例VSD造影测量VSD直径2.6-6.5mm,平均（4.5±2.1）min,选择封堵器直径5-9mm,平均（6.5±1.8）min。技术成功率为100%,术中未发生任何并发症,无急诊手术病例。术后即刻造影或TTE显示2例PMVSD存在微量残余分流,3个月后分流均消失。其余病例无残余分流和再通,心室内径均有不同程度的缩小,肺动脉压下降。结论应用封堵器经导管置入治疗先天性心脏病,具有创伤小、恢复快、操作简单、安全性好、不留手术瘢痕、回收方便、并发症少等优点,是适合先天性心脏病治疗的介入方法。

Objective To evaluate the therapeutic effect of transcatheter closure on patent ductus arteriosus （PDA） and atrial septal defect （ASD） ventricular septal defect （VSD） by using chinamade or imposed occluder device. Methods Ninty - seven patients,including 32 cases with PDA and 31 cases with ASD and 47 cases with VSD, confirmed by transthoracic echocardiography （TYE）, were enrolled into the present study. All patients were treated with occluder devices through the percutancous procedure under fluoros-copy angiography and TIE guidance. Each patient underwent TIE, ECG and chest radiograph examinations at 24 hours and 1,3,6, and 12 months after the procedure, and thereafter annually. Results The narrowest diameter of PDA and ASD and VSD ranged from 2. 3 mm to 8.6 mm （ average 4.3 ±1.5 mm） and 16 mm to 32 mm （average 21 ±2.1 mm） and 2.8 mm to 6.5 mm （average 4.4 ±2. 1 mm） ,respectively;the diameter of occluder selected ranged from 6 mm to 14 mm （ average 8.5 ± 1.8 mm） and 18 mm to 35 mm （ average 26±1.8 mm） and 5 mm to 9 mm （ average 6.5 ±1.8 mm） in PDA and ASD and VSD,respectively. No complications occurred during the procedure. Angiography or TIE examinations after the procedure showed all cases were immediately complete closure of the defect, and only 2 cases of PMVSD had trivial residual shunt. And three months later,the shunt of these cases had completed abolition. TIE examinations showed the inner diameter of ventricle and the pressure of pulmonary were improved in all cases. Conclusions Interventional therapy with occluder device is simple,less harm,to the patients, and with high success rate;it is a safe and efficacious nonsurgical method for congenital heart disease.