双盘对称状封堵器治疗膜部瘤型室间隔缺损的研究

Clinical Research about Membranous Aneurysm Ventricular Septal Defect Treated with Domestic Two-disk-like VSD Occluder

目的分析应用国产双盘对称状封堵器介入治疗膜部瘤型室间隔缺损的疗效。方法2003年3月至2008年5月,沧州市中心医院心内科采用国产双盘对称状封堵器对48例合并膜部瘤的膜周部室间隔缺损行封堵治疗,并于术后1、3、6、12个月复查心电图、超声心动图。结果48例患者中46例封堵成功,成功率95.8%,未成功的2例均因多出口不能完全封堵而建议外科手术。其中36例封堵右心室面破口,10例封堵左心室面破口,术后即刻发生少量残余分流4例,3个月随访时均消失;术中出现脑栓塞1例,2个月后瘫痪肢体完全恢复;术后6d出现间歇性Ⅲ度房室传导阻滞1例,治疗3d后传导阻滞完全消失。结论应用国产双盘对称状封堵器治疗膜部瘤型室间隔缺损安全有效,应根据膜部瘤的位置、形态、破口大小、数目等情况采用不同的方法进行封堵,以达到最佳的治疗效果。

Objective To analyze the effect of domestic made two-disk-like VSD occluder device, on membranous aneurysm ventricular septal defect （VSD）. Methods Forty-eight patients with membranous aneurysm VSD from march 2008 to may 2008 was included. They were all treated with transcatheter occlusion by domestic two-disk-like occluder. EKG and ultrasoundeardiogram were performed about 1,3,6 months and 1 year after the therapy. Results Occlusion was successfully performed in 46 patients,the success rate of the group was 95.8% （46of48） ,2 cases with more holes could not be closed. The defection of right surface on the septum was closed in 36 cases,LVG showed that 42 patients had complete immediate closttre;4 patients had a small shunt immediately after the procedures. TIE revealed that there were no residual shunts in all pa- tients 3 months after the procedure. 1 patient suffered from cerebral embolism in the procedure and recovered in 2 months; 1 patient suffered from spasmodic Ⅲ atrial ventricular block and returned to normal 3d after medication. Conclusion Transcatheter closure of membranous anertrysm VSD using this domestic occluder is safe and effective, It is necessary to choose appropriate technique of closure according to the shape, size and conditions of ventricular septal aneurysm during the interventional procedure in order to achieve the best efficacy.