应用PDA封堵器治疗嵴内型室间隔缺损的疗效及安全性分析

Efficacy of Closing Intracristal Ventricular Septal Defect with Patent Ductus Artery Occluder

目的:评价应用PDA封堵器治疗嵴内型室间隔缺损(IVSD)的疗效及安全性。材料和方法:筛选适合经导管封堵治疗IVSD的患者20例(男11例女9例)。经彩色多谱勒超声心动图测量缺损口大小、距主动脉右冠瓣及肺动脉瓣距离,经皮穿刺股动脉和股静脉,建立动静脉轨道,经7～12F输送鞘管通过右股静脉途径释放封堵器。结果:超声心动图测量的VSD直径5～7mm,平均6.5±0.5mm,大血管短轴切面上缺损位于12点至1点钟位,缺损上缘距主动脉瓣2～3mm,平均2.5±0.5mm。PDA封堵器的直径7～10mm,平均8.5±1.5mm,20例IVSD患者封堵全部成功,术后杂音消失或明显减弱(4/6级降至1～2/6级),左心室造影无分流现象,彩色多谱勒超声心动图检查无主动脉瓣返流,无穿膈血流。随访5个月～6年(平均36±12个月)未见穿隔血流、明显主动脉瓣返流以及传导阻滞等并发症。结论:PDA封堵器可以成功封堵IVSD,近期疗效佳,无严重并发症的发生,远期疗效尚有待于进一步随访观察。

Purpose To evaluate the efficacy and safety of closing intracristal ventricular septal defect（IVSD）with patent ductus artery（PDA）occluder.Materials and Methods 20 patients（11 males and 9 females）with IVSD were selected for treatment.The defect size,its distances between aortic right coronary sinus valve and pulmonary valve were measured by color Doppler transthoracic echocardiography（TTE）.The PDA occluders were released through percuteneous femoral artery and vein route.Results The diameter of IVSD was 6.5±0.5mm.The defect located in the 12 to 1 o＇clock position on the short axis view of great vessels.The distances between IVSD and aortic valve were 23mm.The diameters of PDA occluder were 8.5±1.5mm.The procedures were successful on 20 patients.After the procedure,the murmur disappeared or weakened,no segregation on left ventricular angiography,no aortic valve regurgitation or no blood flow through diaphragm on color Doppler echocardiography showed.No complication were observed during the follow-up from 5 months to 6 years.Conclusion Transcatheter closure of IVSD with PDA occluder was effective and safe,and no serious complication occurred,but need further evaluation on its long term efficacy.