封堵器介入治疗室间隔缺损失败原因影像学分析

Fail reason of transcatheter interventional occlusion of ventricular septal defect: imageology study

目的用影像学方法分析封堵器介入治疗室间隔缺损的失败病例,以提高介入治疗室间隔缺损手术成功率。方法未能成功行室间隔缺损堵闭术47例(47/774),男27例,女20例,年龄2～30岁。对比其手术前后左心室和主动脉造影影像资料。结果膜部瘤破裂15例,其中8例有多个破口,堵闭主要破口后仍有其他的破口分流,2例术前造影只显示单个破口,堵闭破口后出现新的破口,5例封闭基底部后仍存在大量分流;放置堵闭器后出现了中度以上的主动脉瓣反流28例,7例高位嵴下型室间隔缺损,室间隔缺损上缘到主动脉瓣距离小于适应证标准。21例伴有主动脉瓣脱垂,封堵器影响主动脉瓣从而造成主动脉关闭不全;封堵器移位2例;2例术后出现溶血。结论封堵器介入治疗室间隔缺损是安全可靠的治疗方法,但是应该严格把握适应证,恰当地选择堵闭方式和堵闭器,避免治疗失败及术后并发症。

Objectives To analyze the fail reason septal defect by imageology for increasing success rate of transcatheter interventional occlusion of ventricular of interventional treatment. Methods Conventional 47 cases failed transcatheter closure of ventricular septal defects angiography images, 27 men and 20 women; the age ranged from 2 to 30 years, mean 9 years. Results ① 15 cases were ventficular septal defect with aneurysm, among them 8 cases had several crevasse, it had residual shunt after closed the main crevasse; 2 cases appeared another crevasse after closed the main crevasse; 5 cases had volumes of residual shunt after closed fundus. ② 28 cases developed aortic regurgitation. 7 cases were undertracristal VSD, the distances between defect and aortic valve was shorter than standard. 21 cases were complicating aortic valve prolapse, to cause aortic regurgitation, because the aortic valve were interfered by occluders. ③2 cases of displacement of the occluder. ④2 cases had hemolysis after operation. Conclusions Transcatheter interventional occlusion of ventricular septal defect is a safe, effective and ideal method for the treatment of VSD. If indication was correct and occluder was fit, then we can decrease rate of fail, and avoid complication.