室间隔缺损介入治疗五年临床随访分析

Outcome of interventional therapy of perimembranous ventricular septal defects

目的总结分析室间隔缺损（VSD）介入治疗后的随访结果，重点分析其并发症发生情况。方法2002年11月至2007年11月，共有445例膜周部VSD患者接受了介入封堵术，其中男性203例，女性242例，年龄2．5～58（14．2±6．8）岁。所有患者均经股静脉途径放置封堵器，采用的VSD封堵器包括进口偏心伞及国产对称伞。所有患者术后1、3、6、12个月（其后相隔1年）进行门诊随访，复查超声心动图、X线胸片、心电图。结果共有417例患者封堵成功，总技术成功率93．7％（417／445），未发生与手术相关的死亡。至2008年2月，平均随访25．6个月（3个月～5年），严重并发症发生率为2．2％（10／445），其中包括三度房室传导阻滞安装永久起搏器2例、左束支传导阻滞伴左心室增大2例、中-大量主动脉瓣反流2例、中量三尖瓣反流2例、中量二尖瓣反流1例、溶血1例。术后5年有7例患者仍存在少量残余分流，总完全封堵率为98．3％（410／417）。结论VSD介入治疗总体上安全有效。应注意适应证的选择和术后严格随访，以减少严重并发症及晚期并发症的发生。

Objective To observe the outcome of patients with perimembranous ventricular septal defects （VSD） after transcatheter closure. Methods Follow up data were analyzed in 445 VSD patients [203 males, （14.2 ± 6.8 ）years] underwent transcatheter closure （TCVSD） using Amplatzer occluder or homemade occluder in Fu Wai hospital from November 2002 to November 2007. Left ventriculography and ascending aorta angiography were performed before and after TCVSD. Routine follow-up including electrocardiogram, echocardiography and X-ray were made at 1, 3,6 and 12 months post TCVSD and followed at 12 months interval thereafter. Results Mean follow up time was 25.6 months. There was no death during follow up. Procedure was successful in 417 patients （93.7%） and complete closure within 5 years was achieved in 410 patients （98.3%）. During follow up, 2 patients developed complete left bundle branch block and left ventricle enlargement. Complete atrioventricular block was evidenced in 3 patients and 2 patients requiring permanent pacemaker implantations. Newly occurred moderate-large aortic valve regurgitation was found in 2 patients. Newly developed moderate-large tricuspid valve regurgitation was found in 2 patients and moderate mitral valve regurgitation was found in 1 patient. Conclusion Transcatheter closure of perimembranous ventricular septal defects is effective though this procedure is also associated with limited complications.