应用国产对称双盘封堵器经导管治疗膜周部室间隔缺损的临床疗效

Transcatheter closure of perimembranous ventricular septal defects using domestic symmetric double-disk occluders

目的评价应用国产对称双盘封堵器经导管治疗室间隔缺损的安全性及有效性。方法自2003年3月至2007年7月,对我科689例室间隔缺损患者应用国产对称双盘封堵器经导管进行了室间隔缺损的介入治疗,合并房间隔缺损、动脉导管未闭等均进行了同期治疗。并进行术中,术后第1、3、6个月及每年随访,包括12导联心电图及超声心动图检查,观察并发症的情况(有无房室传导阻滞、封堵器形态、对主动脉瓣及三尖瓣的影响以及有无残余分流等),评估该方法的安全有效性。结果总体技术成功率为98.8%。因术后脑出血死亡1例,因Ⅲ度房室传导阻滞安装永久性心脏起搏器1例,半年后因三尖瓣中-重度关闭不全转外科手术1例,6例改用Amplatzer偏心伞进行封堵成功;2例封堵失败转外科手术。其余随访期间未出现明显并发症。结论应用国产对称双盘封堵器经导管治疗室间隔缺损术后出现各种与手术有关的并发症的几率较低,具有很强的安全性和可行性,应成为室间隔缺损患者的首选治疗方案,但同时应掌握好适应证,注意三尖瓣关闭不全等并发症的预防。

Objective To evaluate the safety and efficacy of transcatheter closure of perlmembranous ventricular septal defects （VSD） using domestic symmetric double-disk occluders. Methods From March 2003 to July 2007, 689 VSD patients were treated with transcatheter intervention using domestic symmetric double-disk occluders and received clinical follow up at 1 month, 3 months, 6months after the procedure and annually thereafter. Complications including residual shunt, heart rhythm changing, shape of the occluder and the presence of tricuspid/aortic regurgitation were observed thoroughly. Results The overall technical success rate was 98. 8%. One patient died of cerebral bleeding 7 days after intervention. One patient suffered complete A-V block and required permanent pacemaker implantation and another patient conversed to open surgery because of moderate tricuspid regurgitation. Asymmetric Amplatzer occluders were used in 6 patients but the intervention failed in 2 patients whom required an open conversion. Comorbidities such as atrial septum defect, patent foramen ovale were treated concomitantly. No other complications were observed during the follow-up period. Conclusion Complication associated with transcatheter closure of perimembranous VSD using domestic symmetric double-disk occluders was relatively low. The procedure was safe and applicable. Meanwhile, it is necessary to stick to the procedural indications and avoid complications such as tricuspid regurgitation etc.