微创经胸右室穿刺封堵婴儿室间隔缺损45例报告

Minimally Invasive Perventricular Device Closure of Perimembranous Ventricular Septal Defect in Infants(a report of 45 cases)

目的总结非体外循环下经胸右室穿刺封堵治疗婴儿室间隔缺损（VSD）的经验。方法采用全麻下胸骨下段小切口经右心室穿刺封堵婴儿VSD 45例。男性27例,女性18例,年龄（7±4.6）月（3-12月）,体质量（9±3.5）kg（4.5-12 kg）;VSD均为膜部或膜周部,缺损直径4-8 mm。结果成功植入VSD封堵器42例,使用封堵伞6-10#,其中偏心伞9例;2例主动脉瓣关闭不全加重放弃而改常规体外循环下修补缺损,1例膜部瘤导引钢丝无法通过缺损而改体外循环修补。全组无手术死亡,手术后并发一过性血红蛋白尿1例,无Ⅲ度房室传导阻滞并发症。随访3-20月,无心律失常,无残余漏。结论经胸右室穿刺封堵VSD在婴儿先天性心脏病中应用可行、安全,中期随访效果满意。

Objective To summarize the experience of minimally invasive transthoracic device closure of ventricular septal defect（VSD）.Methods From Feb.2009 to Aug.2010,there were 45 cases of ventricular septal defect patients aged 3~12 months,who underwent minimally invasive device closure with an inferior sternotomy of 3 cm under transesophageal echecardiographic guidance.The delivery system included trocar,guidewire,proper sheath,and loading sheath.The proper size of occluder devices was determined by means of transesophageal echocardiographic.All were paramembraous ventricular septal defect.Of them,27 male cases,18 female cases,body weight（9±3.5）kg（4.5 to 12 kg）.Results 42 cases of VSD were successfully closed by the device with 6~10# occluder,3 patients were converted to be repaired under cardiopulmonary bypass.There was one case hemogloinuria postoperatively.Neither residual shunt nor noticeable aortic regurgitation nor tricuspid regurgitation nor significant arrhythmias appeared during 3 to 20 months of follow-up.Conclusion Minimally invasive transthoracic device closure of perimembranous ventricular septal defects in infant patients is feasible and safe under transesophageal echocardiographic guidance.The intermediate result is good.