室间隔缺损介入封堵治疗失败原因分析

Analysing on failure in transcatheter closure of ventricular septal defect

目的 分析室间隔缺损介入封堵失败病例,提高术前超声心动图筛选患者的手术成功率.方法 对50例室间隔缺损介入封堵手术失败患者的超声心动图检查结果进行分析.结果 14例术中出现房室传导阻滞,13例术后有残余分流,19例无法建立封堵轨道,2例嵴内置人封堵器后出现较明显的主动脉瓣反流,1例冠心病、1例急性心肌梗死伴室间隔穿孔,以上患者均未能完成手术.结论 应用超声心动图注意观察室间隔缺损的左右室侧大小及周边结构.对年龄较小、缺损复杂或年龄较大合并冠心病的患者,应慎用封堵方法.

Objective To analyse the failure reason in transcatheter closure of ventricular septal defect（VSD） ,in order to improve the succeeding rate of occlusive operation on screening VSD patients with echocardiography. Methods Echocardiographic datas were summarized in 50 cases who were failed in VSD occlusion. Results Atrio-ventricular block was occurred in 14 patients,residual shunt was visualized in 13 cases,transcatheter occlusive track could not be set up in 19 cases,arotic valve regurgitation in two cases were screened obviously after occlusive device was released into the intracristal VSD. One case was suffered from cononary heart disease（CAD） and another one was suffered from acute myocardial infarction with ventricular septal perforation. All these patients did not succeed in closure procedure. Conclusions The defect sizes of left and right sides of ventricular septal, structure close to defect must be considered in selecting patients before operation by echocardiography. Occlusion operation should be strictly chosen in cases who were children,or suffered from complex VSD,or senior patients with CAD.