小腰大边型封堵器在膜部瘤室间隔缺损介入治疗中的应用

Application of interventional therapy using A4B2 (thin waist type)occluder for perimembranous ventricular septal defect with aneurysm

目的探讨小腰大边型封堵器在室间隔膜部瘤介入治疗中的应用及疗效。方法回顾性分析68例室间隔缺损伴膜部瘤患者进行小腰大边封堵器介入治疗的临床资料,术中左心室造影,根据瘤体形态分为4种类型,选择4～14mm封堵器进行封堵。术后24h、1个月、3个月、6个月、12个月予以胸片、心电图、经胸超声心动图检查。结果本组68例采用小腰大边封堵器进行封堵室间隔缺损的患儿,成功率94%(62/68)。术后24h复查超声心动图,8例少量残余分流。术后1年复查残余分流消失。术后随访,6个月时右心室流出道(RVOT)血流速度降低,心/胸比例(C/T)、肺动脉平均压(MPAP)、左心室舒张末内径(LVEDD)、左心室舒张末压力(LVEDP)均有下降,左心室短轴缩短率(FS)升高(P<0.01)。9例传导阻滞患者心电图术后3个月均恢复正常。结论小腰大边型封堵器在室间隔膜部瘤介入治疗中的应用是安全和可行的。

Objectives To evaluate the effectiveness of interventional therapy using A4B2 （thin waist type） occluder for perimembranous ventricular septal defect with pseudoaneurysm. Methods We used thin waist type occluder in interventional therapy for the 68 patients with perimembranous ventricular septal defect with pseudoaneurysm. The ventricular septal defects with aneurysems were classified into four types and measured by left ventriculography. The diameter of the occluders ranged from 4-14 mm.Transthroacic echocardiograohy （TTE）,chest X-ray and electrocardiogram （ECG）were performed 24 h and 1,3,6,12 months after intervention. Results Among the 68 patiens,success rate of transcatheter closures was 94% （62 / 68）. Residual shunt was found by TTE in 8 patients 24 h after intervention and disappeared in 12 months. The ratio for cardiac and thoracic size （C / T）,blood flow velocity of right ventricular outflow tract （RVOT）,mean pulmonary artery pressure,left ventricular end-diastolic pressure （LVEDP）,and left ventricular end-diastolic diameter（LVEDD） all decreased,fraction shortening （FS）increased,and the differences were significant 6 months later. ECG transient block in 9 patients disappeared 3 months later. Conclusions A4B2 （thin waist type） occluder for interventional therapy to perimembranous ventricular septal defect with pseudoaneurysm was safe and effective.