室间隔缺损患者介入治疗后严重并发症及其防治—附9例报道

Preventions and Treatments towards the Severe Complications after the Interventional Therapy of Ventricular Septal Defect ;A report of 9 cases

目的探索室间隔缺损患者经介入治疗后出现严重并发症发生的原因,并提出相关防治措施。方法选择2003年1月至2009年12月因室间隔缺损(VSD)而在我院接受经导管介入治疗失败而再行外科手术的患者,共9例病例进行回顾性分析,查找介入手术失败原因。其中5例介入手术后即因血压不稳、恶性心律失常等并发症手术开胸,撤除封堵器,并同期修补室间隔缺损。术中发现封堵器脱落1例、压迫传导束导致房室传导阻滞(AVB)4例。介入术中出现循环异常回收封堵伞4例,AVB2例,超声证实主动脉瓣关闭不全(AI)1例、三尖瓣关闭不全(TI)1例,4例患者行择期开胸手术治疗纠正心内畸形。结果 1例封堵器脱落患者开胸手术证实封堵器缠绕于三尖瓣腱索。4例AVB者术后均恢复窦性心律。TI患者术中发现三尖瓣腱索断裂。所有患者心内畸形修复完善,患者康复出院。结论介入手术在治疗先天心脏病方面有很大的优势,但出现严重并发症时应及时采取外科手术干预,及时纠正介入手术并发症。

Objective The aim of this study is to identify potential reasons of these severe complications of the interverntional therapy with the VSD and to explore relevant preventions and treatments.Methods This study is a retrospective analysis of patients（n =9） from Xijing Hospital（Xi＇an,China） with failed transcatheter intervention for VSDs who subsequently underwent open heart surgery.Four patients experienced complications during transcatheter intervention,including third-degree atrioventricular block（ⅢAVB）（n=2）,aortic incompetence（n =1）,and tricuspid incompetence（n=1）.The devices were immediately removed in the catheterization laboratory followed by open heart surgery to repair VSDs.Five patients experienced complications after transcatheter intervention 1 patient＇s device was displaced into the right ventricle,and 4 patients had Ⅲ_ AVB.These patients underwent surgery to retrieve the devices and to repair VSDs.All cardiac surgery was performed under general anesthesia and under cardiopulmonary bypass.Results 1 VSD patient had the occluder dropped and wrapped by the chordae tendineae of the tricuspid valve,fixed in the right ventricle.The cardiac rhythm of the 4 patients who had the ;AVB were returned to the sinus rhythm after the surgery.All the patients＇ VSD were repaired simultaneously,with no death or residual shunt.Conclusions Transcatheter interventional VSD closure is safe and effective,but only under the conditions of strict patient selection,proper technique,and device application.Once severe complications are observed and diagnosed,devices should be retrieved immediately,and open heart surgery should be performed to avoid further injury.