Amplatzer血管塞封堵先天性心脏病异常血管畸形的临床应用

Clinical application of the Amplatzer vascular plug in the embolization of vascular malformations associated with congenital heart diseases

目的评价Amplatzer血管塞(AVP)封堵先天性心脏病异常血管畸形的临床疗效。方法2006年6月至2008年6月共有12例患者接受AVP封堵治疗,其中单发及多发囊状肺动静脉瘘7例,冠状动脉右室瘘2例,法洛四联症大型体肺侧支3例。均经临床和经胸超声心动图(TTE)及胸部CT造影筛查,并经心血管造影证实。结果本组均应用AVP有效封堵异常血管畸形,造影判断即刻成功率为100%,无移位、脱落等早期并发症。封堵血管16支,平均内径(5.2±1.9)mm,所用AVP直径为(9.2±2.4)mm。所有患者封堵术后平均3个月随访心超和(或)胸部CT造影,显示封堵血管闭塞良好,无异常、无残余分流。结论经导管应用AVP封堵先天性心脏病血管畸形是一种安全、有效的治疗方法,能显著改善患者生活质量,值得临床进一步推广。

Objective To evaluate the clinical efficacy of percutaneous transcatheter embolization by using Amplatzer vascular plug （AVP） for the treatment of vascular malformations associated with congenital heart diseases. Methods During the period of June 2006-June 2008, 12 patients with congenital heart disease accompanied by vascular malformations received transcatheter occlusion of the anomalous vessels with AVP. The vascular malformations included solitary or multiple saccular pulmonary arteriovenous malformation （n = 7）, coronary artery fistula （n = 2） and major aortopulmonary collaterals concomitant with severe Fallot＇ s tetralogy （n = 3）. All patients were screened with transthoracic echocardiography （TTE） and thoracic CT angiography （CTA）, and all the diagnoses were confirmed by routine cardioangiography. Results Transcatheter occlusion of vascular malformations with AVP was successfully accomplished in all 12 patients. An angiographic check immediately after the procedure showed that complete occlusion was obtained in all patients and no embolism, nligration or residual shunt were seen. Sixteen anomalous vessels were occluded. The mean internal diameter of these vessels was （5.2 ± 1.9） mm, while the mean diameter of AVP used was （9.2 ± 2.4） mm. After the operation （mean 3 months）, the follow-up echocardiography and/or thoracic CT angiography showed that in all patients the occlusion remained in satisfactory condition and no residual shunt was found. Conclusions Percutaneous transcatheter closure of congenital vascular malformations with AVP is technically feasible and clinically effective, this treatment can markedly improve patient＇s living quality and it is well worth extending its clinical application.