心血管介入治疗室间隔膜部缺损的临床分析

Clinical analysis of Cardiovascular Interventional Therapy of Perimembranous Ventricular septal Defect

目的探讨经导管介入治疗室间隔膜部缺损（VSD）的可行性、方法及疗效。方法 30例室间隔膜部缺损患者,男18例,女12例,年龄在10~57（27.2±11.5）岁。术前心脏超声检查确诊为膜周部缺损VSD,缺损直径2~8（4.6±1.6）mm,缺损上缘距主动脉瓣2~5（2.7±0.8）mm。30例患者均于术中先行左心室造影,5例合并存在膜部膨胀瘤,且其中1例同时合并两处室间隔缺损,29例患者确定适合行膜部VSD封堵术。结果 28例均应用Amplatzer封堵器介入治疗成功,1例存在两处室间隔缺损合并膜部膨胀瘤者,建议外科手术治疗;1例合并膜部膨胀瘤患者封堵后存在明显分流封堵未成功。成功病例随访9~48个月,经胸超声心动图检查提示封堵器位置稳定,无残余分流,无相关并发症发生。结论在严格选择适应证和有熟练操作技巧的条件下,心血管介入治疗膜部VSD是一项操作安全、疗效可靠的治疗方法,具有创伤小,恢复快等优点。

Objective To evaluate the feasibility,methods and efficacy of the transcatheter interventional therapy for membranous ventricular septal defect（VSD）.Methods 30 cases of membranous ventricular septal defect patients,18 males and 12 females,10 to 57 years old,with an average age of 27.2±11.5.Preoperative echocardiography confirmed perimembranous defect VSD,defect diameter of 2～8mm,an average of（4.6±1.6）mm,defect from the upper edge of the aortic valve 2～5mm,an average of（2.7±0.8）mm.30 patients were in operation had taken left ventricular angiography at first,5 cases of membranous have expansion of tumors in combination,and of which 1 case associated with two ventricular septal defect,29 patients were to determine appropriate line of membranous VSD occlusion.Results 28 patients that applied Amplatzer duct occluder were treated successfully,1 case of the two membranous ventricular septal defect with aneurysm expansion,it is recommended surgical treatment;1 case of combined membranous expansion of aneurysm occlusion in patients after the closure there is obvious diversion.The successes were followed up of 9 to 48 months,transthoracic echocardiography prompted occluder position stability,and no residual shunt,no related complications.Conclusions In the strict selection indication and under the conditions of proficiency in skills,cardiovascular interventional treatment membranous VSD is a safe,effective and reliable treatment,with less trauma and faster recovery and so on.