三尖瓣腱索附着异常的膜周部室间隔缺损介入治疗初步探讨

Preliminary Investigation of Transcatheter Intervention on Perimembranous Ventricular Septal Defects With Abnormally Attached Chordae Tendinaeas of Tricuspid Valve

目的:探讨三尖瓣腱索附着异常的膜周部室间隔缺损(VSD)应用特制的"类柱状封堵器"介入治疗的可行性及近期疗效观察。方法:术前超声检查筛选出5例VSD的患者均伴有三尖瓣腱索附着异常。5例患者均选择特制"类柱状封堵器"堵闭VSD。术后24 h、1个月、6个月行超声心动图、心电图检查随访观察。结果:5例患者均一次封堵成功。术后复查心电图,未发现严重新发的心律失常。术后24 h超声心动图检查,封堵器形态、位置良好;4例心腔大小较术前均有所缩小,1例缺损较小,心腔大小正常无明显变化;三尖瓣反流1例较术前增多。术后6个月超声心动图检查,4例心腔大小均回缩至正常;1例心腔大小正常患者无明显变化;1例较术前三尖瓣反流量增多患者术后1个月、6个月均无明显变化;无其他并发症发生。结论:特制"类柱状封堵器"可用于三尖瓣腱索附着异常的膜周部VSD介入治疗中,即刻及近期疗效可靠,未发现严重的三尖瓣反流及其他并发症。

Objective：To investigate the feasibility and short-term outcome of interventional catheterization by ＂ similar to Columnar Occluder＂ for perimembranous ventricular septal defects（PMVSD）with abnormally attaehed chordae tendinaeas of tricuspid valve. Methods ： We found 5 patients of PMVSD with abnormally attached chordae tendinaeas of tricuspid valve by echocardiography before the intervention. The patients were closured with tailor-made ＂ similar to Columnar Occluders＂, and all of them were followed-up by eehoeardiography and ECG at 24 hours,1 month and 6 months after the intervention. Results ： All patients were successfully clusured at one time, no severe novel arrhythmia was found by ECG. Echocardiography presented that the shape and location of occlnders were good at 24 hours after the intervention. 4 patients had decreased dimension of cardiac chamber right alter the intervention,and the cardiac chambers shrinked to normal 6 months later. 1 patient had less defect and had no obvious ebanges after the treatment. 1 patient showed the increased volume of tricuspid regurgitation after the intervention and had no real changes 6 months later. No other post-operative complications were observed. Conclusion：The tailor-made ＂ similar to Columnar Occluder＂ is safe in transcatheter occlusion in patients of PMVSD with abnormally attached ehordae tendinaeas of tricuspid valve. The immediate and short-term outcomes are reliable.