23例小儿室间隔缺损的镶嵌治疗

Hybrid procedure performed in 23 children with ventricular septal defect.

目的探讨镶嵌手术（hybrid procedure）治疗室间隔缺损的方法及临床疗效。方法2006年1月至2008年7月，在经食管超声心动图（TEE）辅助下，采用镶嵌手术治疗室间隔缺损23例。其中15例经有心室表面穿刺置入封堵器，4例在体外循环（CPB）下直视置入封堵器，4例在CPB下置入封堵器后同期手术矫治其他畸形。结果23例均获成功，14例膜部室间隔缺损封堵器直径6～12mm，9例肌部室间隔缺损封堵器直径5～10mm。术后恢复顺利，心功能正常，超声随访无残余分流、主动脉瓣返流及周围组织卡压。结论将心脏外科手术与内科介入相结合的镶嵌治疗是小儿先天性心脏病的新型治疗模式，简化了，手术过程，降低了嗣手术期并发症及病死率，从而降低了手术风险。

Objective To summarize the technique and clinical experience with hybrid procedure performed in children with ventricular septal defeet （VSD）. Methods Frmn January 2006 to July 2008, 23 cases of VSD underwent hybrid procedure under the guidance of transesophageal eehocardiography. Perventricular VSD closure technique was performed in 15 patients, direct closure of defect with device under cardiopuhnonary bypass in 8 （4 of them were simple VSDs and the other 4 were VSDs concomitance with other heart lesions requiring surgical repairs）. Results Twenty-three cases obtain satisfactory outcomes. The size of the device for perimembranous VSD closure ranged 6-12mm, while muscular VSD was 5-10mm. The postoperative recovery was smoothly. All cases recover smoothly after the treatment without residual shnnting, aortic regurgitation or restriction of surrounding structures. Conclusions Hybrid procedure combines surgical technique and interventional procedure. It is safe and effective for the closure of congenital heart defects.