国产动脉导管封堵器闭合膜周部室间隔缺损的疗效评价

Transcatheter closure of perimembranous ventricular septal defect using domestic patient ductus arteriosus occludersTranscatheter closure of perimembranous ventricular septai defect using domestic patient ductus arteriosus occluders

目的评价国产动脉导管（PDA）封堵器闭合膜周部室间隔缺损（VSD）的可行性、安全性及疗效。方法2004年5月至2008年7月，21例先天性膜周部VSD患者[男性10例，女性11例，年龄5～40（21．3±10．2）岁]成功接受了封堵治疗。膜周部VSD的直径均先经经胸心脏彩超检查（TTE）测量，并经左心室造影进一步明确。封堵操作完成10min后再次予TTE及左心室造影评估封堵效果。术后心电监护1周，出院前及出院后1、3、6个月随访复查TTE及心电图。结果21例患者均全部封堵成功，国产PDA封堵器尺寸为6／8～18／20mm。封堵后，2例新出现微量主动脉瓣反流，1例出现少量的三尖瓣反流；3例出现完全性或不完全性右束支传导阻滞，1例出现完全性左束支传导阻滞，1例出现不完全右束支合并间歇性完全性左束支传导阻滞，除2例完全性或不完全性右束支传导阻滞在6个月内随访时未恢复外，其他3例均在出院前恢复正常；4例存在微量残余分流，其中3例在7d后复查超声时消失，另1例在1个月随访时消失。术前TTE估测肺动脉压力为28．0～46．7（33．4±9．2）mmHg，术后肺动脉压力为16．0-30．2（19．2±7．6）mmHg，6个月随访时肺动脉压力进一步下降为15．3-26．7（17．3±6．9）mmHg。结论对部分膜周部室间隔缺损的患者应用PDA封堵器进行封堵是可行的、安全的及有效的。

Objective To evaluate the feasibility,safety and efficacy of transcatheter closure of perimembranous ventricular septal defects （VSD） with the domestic PDA oceluder devices. Methods From May 2004 to July 2008, transcatheter closure was deployed in 21 patients （10 men and 11 women）, age ranged from 5 to 40 （21.3＋10.2） years with congenital perimembranous ventricular septal defects. The diameters of VSD measured by transthoracic echocardiography （TYE） were confirmed by left ventriculography. Left ventriculography and transtho- racie eehoeardiography were performed repeatedly to assess the effect of occlusion at 10 min after the procedure with electrocardiogram monitoring for one week. The transthoracie echocardiography and electrocardiography were scheduled before discharge, and at 1,3 and 6 months for the follow-up. Results The oceluders were all deployed successfully in 21 patients,and the size of domestic PDA oeeluders ranged from 6/8 to 18/20 mm. After the procedure,2 cases showed trivial aortic valve regurgitation, 1 case showed small tricuspid valve regurgitation,3 cases developed complete or incomplete right bundle branch block, 1 case developed complete left bundle branch block, 1 case developed incomplete fight bundle branch block accompanied with intermittent complete left bundle branch block, of those developed bundle branch block 3 cases recovered before discharge, and 2cases were still complicated with complete or incomplete right bundle branch block during 6 months follow-up, 4 cases complicated with trivial residual shunt, among those 3 cases disappeared 7 days later, the other case dispeared in one month of follow-up by transthoracic echocardiography. The pulmonary arterial pressure measured by TrE before the procedure ranged from 28.0 to 46.7 （33.4＋9.2） mm Hg, and decrease from 16.0 to 30.2 （19.2：t：7.6） mm Hg after the procedure, continued to decrease at 6-month follow-up. Conclusion Transcatheter closure of perimembranous ventricular septal defect using the domestic PDA occluder devices is feasible, safe and effective in some cases.