急性心肌梗死并发室间隔穿孔患者介入治疗的初步应用

Experience of transcather closure in patients with postinfarction ventricular septal defects

目的评价急性心肌梗死并发室间隔穿孔封堵治疗的疗效。方法12例临床经心电图、心肌坏死标记物及心脏超声确诊为急性心肌梗死并发室间隔穿孔的患者，经药物治疗调整心功能后实施介入治疗封堵术，其中2例患者择期实行冠状动脉造影球囊扩张（PTCA）及支架置入术。结果（1）全部12例患者，缺损累及膜周部2例，肌部10例（其中心尖部3例）；12例患者，9例封堵成功，9例患者存活；相关的并发症封堵器脱落2例和恶性心律失常（心事颤动）1例。（2）室间隔穿孔发生到行封堵术的时间间隔为（15．5±9．2）d，9例存活患者术后至出院天数为（11．3±5．2）d。（3）2例患者同时均经冠状动脉造影成功地于严重狭窄处共置入支架4枚。结论采用导管法封堵急性心肌梗死并发室间隔穿孔能在一定的程度上降低病死率，但技术有待于进一步完善和发展。

Objective To evaluate the therapeutic effect of transcather closure in patients with postinfarction ventricular septal defects （VSD）. Methods Trauscatheter VSD closure was performed in 12 patients with postinfarction VSD （10 muscular and 2 membranes defects ） on top of standard pharmaeotherapy and percutaneous transluminal coronary angioplasty （ PTCA ） as indicated. Results （ 1 ） Pereutaneous interveutional VSD closure was successful in 9 out 12 patients （75%） and these 9 patients survived post procedure. （2）The medial time between VSD occurrence and closure was （ 15.5 ±9. 2） days. Procedure-related complications such as device embolizafion and malignant arrhythmia occurred in 3 patients （25%）. The medial time between procedure and discharge from hospital was （11.3 ± 5.2） days. （3） Coronary angiography was performed in 2 patients and 4 stents were implanted in diseased lesions. Conclusion Transcatheter closure could be successfully performed in selected patients with nostinfaretion VSD.