国产细腰型室间隔缺损封堵器治疗主动脉窦瘤破裂的疗效与安全性

Safety and efficacy of a domestic made small-waist ventricular septai defect occluder for transcatheter closure of ruptured aneurysm of the sinus of Valsalva

目的观察国产细腰型室间隔缺损封堵器治疗主动脉窦瘤破裂的疗效和安全性。方法随机入选2005年9月至2010年12月在长海医院心内科行主动脉窦瘤破裂经导管介入治疗的患者7例，年龄（43．5±13．0）岁。术前均通过超声心动图检查确诊为主动脉窦瘤破裂。术中行升主动脉造影，判断破裂口直径。选择较缺损直径大4—6mm的国产细腰型室间隔缺损封堵器，经股静脉逆行途径实施封堵。术后进行随访，观察心律改变、残余分流、封堵器形态、有无瓣膜反流等情况，评价治疗效果。结果7例主动脉窦瘤破裂均经升主动脉造影确诊，其中6例患者右冠状动脉窦瘤破裂入有心室，1例患者无冠状动脉窦瘤破裂入有心室。升主动脉造影显示，破裂口直径为4～7（5．0±1．3）mm。左心室造影显示，合并室间隔缺损2例。所有缺损均封堵成功，其中2例同期行室间隔缺损封堵术。经导管介入治疗后，患者肺动脉收缩压由（35．6±12．7）mmHg（1mmHg=0．133kPa）下降至（27．4±6．2）mmHg（P〈0．05），肺动脉平均压由（21．9±8．0）mmHg下降至（16．1±5．3）mmHg（P〈0．05）；封堵后心脏杂音消失；术中超声心动图发现1例封堵器内微量残余分流，次日复查超声心动图显示残余分流消失；所有患者均未观察到主动脉瓣反流、溶血、心律失常。随访6～12个月，患者未发生血栓事件、感染性心内膜炎、右心衰竭及死亡。结论应用国产细腰型室间隔缺损封堵器经导管介入治疗主动脉窦瘤破裂的疗效好，安全性高。

Objective To evaluate the safety and efficacy of transcatheter closure of ruptured aneurysm of the sinus of Valsalva （RAVS） using a domestic made small-waist ventricular septal defect occluder. Methods Between September 2005 and December 2010, transcatheter closure of RAVS was randomly performed in 7 patients of （43.5 ± 13.0）years old using domestic made small-waist ventricular septal defect occluder in our department. RAVS was diagnosed by color Doppler echocardiography. The size of the small-waist double-disk occlude selected was 4 to 6 mm larger than the narrowest diameter of the opening of aneurysm. After establishment of the arteriovenous wire loop, the device was deployed by retrograde venous approach in all patients. All patients were followed up in terms of rhythm change, residual shunt, shape of occlude, and possible valve regurgitation by echocardiography for 6 to 12 months. Results All RAVS were confirmed by aortography. Aortography showed rupture of right coronary sinus into the right ventricle in 6 patients and non-coronary sinus ruptured into right ventricle in another patient. The estimated size of tile defect was 4 to 7 （ 5.0± 1.3 ） mm by aortogram. Ventricular septal defect was evidenced in 2 patients. All defects were successfully occluded without complication. Two patients with ventricular septal defect received combined percutaneous ventricular septal defect closure. After transcatheter RAVS occlusion, pulmonal-y artery systolic pressure decreased from （35. 6 ± 12.7）mm Hg （ 1 mm Hg =0. 133 kPa） to（27. 4 ± 6.2）mm Hg（P 〈0.05）, and mean pulmonary artery pressure decreased from （21.9± 8.0）mm Hg to （16. 1±5.3）mm Hg （P 〈 0. 05 ）. Cardiac murmur disappeared right after successful occlusion. Echocardiography detected a trace of residual shunt in one patient after occlusion which disappeared the next day. There was no aortic regurgitation, hemolysis and arrhythmia during hospitalization. There was no device embolization, infective endocarditis, right heart failure and death during the 6 to 12 months follow- up. Conclusion Transcatheter closure of RAVS with the domestic made small-waist ventricular septal defect occluder is safe and effective.