房间隔缺损与室间隔缺损介入治疗失败后外科手术疗效分析

Effect of surgical closure of atrial septal defect and ventricular septal defect after the failure of interventional therapy

目的:分析房间隔缺损(ASD)和室间隔缺损(VSD)介入治疗失败后外科手术的效果。方法:选择2000年1月至2007年12月在我院接受经导管介入治疗ASD(12例)和VSD(4例)失败后需再行外科手术的16例,其中封堵器脱落7例,心脏穿孔3例,Ⅲ°房室传导阻滞(AVB)2例,瓣膜关闭不全2例(其中1例合并Ⅲ°-AVB),残余漏和封堵失败各1例。手术均在体外循环下进行,取出封堵器,修复心内畸形,术后入ICU监护。结果:ASD介入治疗患者中,手术探查ASD直径平均31 mm,较术前经彩色多普勒超声心动图诊断的平均直径26 mm增大(P<0.05)。ASD部位为中央型5例,下腔型7例,与术前诊断相符率41.7%,不相符率58.3%。VSD直径平均5 mm,与术前差异无统计学意义。VSD部位为膜部2例,流出部与肌部各1例。3例Ⅲ°-AVB患者术后均恢复窦性心律。心内畸形修复完善,无手术死亡。结论:及时采取外科手术治疗介入封堵失败后并发症,效果良好,安全可靠,并可避免并发症造成的不良后果。

Objective：To analyse the effect of surgical closure of atrial septal defect（ASD） and ventricular septal defect（VSD） after the failure of interventional therapy.Methods：16 patients underwent surgical closure of ASD and VSD after the failure of interventional therapy from January 2000 to December 2007.Among the 16 patients,7 experienced dislodgment of device.Other complications： cardiac perforation in 3？？？？？atrioventricular block（AVB） in 3？？valvular regurgitation in 2（？？？AVB in 1）？？residual shunt in 1？？unsuccessful interventional closure in 1.All patients were transferred into ICU for further treatment postoperatively.Results：The mean diameter of ASD（31 mm）found in operation was larger than that（26 mm） measured by echocardiography before operation（P0.05）.12 ASD cases were performed after the failure of interventional treatment including 5 cases with central ASD,7 cases with inferior venae cavae ASD.The postoperative rates of diagnosis and misdiagnosis were respectively 41.7% and 58.3% compared with preoperative ones.The 3 patients with ？？？VB were sinus rhythm postoperatively.No patients died perioperatively.Conclusion：Proper and timely surgical treatment is an efficient and safe approach for complications after failure of interventional therapy and can avoid negative outcomes of serious complications.