经心室穿刺封堵婴幼儿非肌部室间隔缺损39例

Clinical study of perventricular device closure of non-muscular ventricular septal defects in 39 infants

目的探讨经心室穿刺封堵婴幼儿非肌部室间隔缺损（VSD）的临床效果。方法2007年4月至2008年2月，治疗39例非肌部VSD病儿，男16例，女23例。年龄12～36个月，平均（14．5±7．8）个月；体重8．5～18．0kg，平均（12．4±2．3）kg。其中膜周部VSD34例、干下型3例、嵴内型2例。缺损直径3．0～11．0mm，平均（6．1±2．0）mm。均接受非体外循环下经右心室穿刺封堵VSD治疗。结果全组均无需输血。37例封堵成功，2例因发生中度主动脉瓣反流改行直视手术。置人封堵器直径4～12mm，平均（8．24-2．0）mm。术后膜周部VSD者中三尖瓣反流程度减轻3例，新出现微量至轻度三尖瓣反流8例；6例出现不完全性右束支传导阻滞。术后住院3～5d，平均（3．4±0.4）d。结论经心室穿刺行VSD封堵术对婴幼儿非肌部VSD而言是一种有效和安全的治疗手段。

Objective To evaluate the effect of perventricular device closttre of non-ranseular ventricular septal defects （VSDs） in infants. Methods From April 2007 to February 2008, 39 patients with non-mnscular VSDs were received off pump surgical treatment, perventricular device closure were used for all the patients. There were 16 males and 23 females with mean age of （ 14.5 ± 7.8） months （12 to 36 months and mean weight of （12.4±2.3） kg（8.5 to 18.0 kg）. There were 34 perimembranons and 5 subaterial VSDs. The diameter of defects were 3 . 0 to 11 mm [mean （6.1±2.0） mm]. Results Thirty-seven （94.9%） VSDs were successfully closed, while two were repaired under cardiopulmonary bypass （CPB） instead ef device closure because of the corrtphcation of moderate aortic regurgitation. The diameter of occluders were 4 to 12 mm [mean （8.2 ± 2.0） mm]. The tricuspid regurgitations decreased after operation in 3 patients with perimembranous VSDs, while the closure caused new mild or trace tricuspid regurgitations in 8 patients. Six patients with perimembranons VSDs acquired the incomplete right bundle branch blocks after device closure. The length of hospital stay was 3 to 5 days [ mean （3.4 ± 0.4 ） ] after operation and no patient had blood transfusion. Conclusion Perventricular device closure is probably an effective and safe treatment for non-museular VSDs in infants.