假性膜部瘤型室间隔缺损的介入封堵治疗

Transcatheter Closure of Ventricular Septal Defect with Pseudoaneurysmof Perimembranous Septum

目的评价应用室间隔缺损封堵器闭合假性膜部瘤型室间隔缺损的可行性、安全性和疗效,并总结其技术难点与临床策略。方法2005-12/2008-12月,采用国产膜部室间隔缺损封堵器对37例假性膜部瘤型室间隔缺损行封堵治疗,封堵术前常规行左室造影,在经胸超声心动图及透视监测下通过建立股动静脉轨道、经右心系统释放封堵器,并于术后3、6、12个月随访复查胸片、超声心动图、心电图。结果37例假性膜部瘤型室间隔缺损患者全部成功行封堵术,技术成功率100%。其中11例采用封堵瘤体法,26例采用封堵左室面破口法。术后即刻发生少量残余分流3例,3个月随访时消失。结论应用室间隔缺损封堵器治疗假性膜部瘤型室间隔缺损疗效可靠,操作简便,使用安全。术中要根据假性膜部瘤型室间隔缺损的位置、形态、破口大小、数目等情况采用不同的封堵方法进行封堵,以达到最佳的治疗效果。

Objective To evaluate the feasibility, safety and efficacy of ventrieular septal defect（VSD） occluder on ventricular septal defects with pseudoaneurysm of perimembranous septum, and to summarize the technological difficulty and clinical strategy. Methods Transcatheter closure was performed in 37 patients with ventricular septal defects combined with pseudoaneurysm of the membranous septum. The delivery sheath was advanced across the membranous VSD over a guide wire from femoral vein for deploying the occluder under the guidance of transthoracic echocardiography （TEE） and ventriculography. TEE was performed repeatedly to assess the effect of occlusion 3, 6, 12 months later. Results The occluders were deployed successfully in 37 patients. After procedure 34 of 37 patients showed no residual shunt, and trivial residual shunt appeared in 3 patients but disappeared 3 months later. The waste of devices were placed succesefully to left ventricular orifice in 26 cases, and the left plate of occluder were placed to body of pseudoaneurysm in another 11 cases. Conclusion Transcatheter closure of ventricular septal defects with pseudoaneurysm of membranous septum is effective, easy and safe. The key of the technology is the morphology characteristics of ventricular septal defects with aneurysm of the membranous septum and the selection of occluder.