TEE引导短输送系统经胸微创封堵室间隔缺损

TEE guided minimally invasive perventricular device closure of congenital ventricular septal defect with short delivery system

目的:探讨在食道超声心动图(TEE)引导下应用短输送系统经胸微创小切口封堵室间隔缺损(VSD)的临床经验。方法:39例室间隔缺损患儿,男13例,女26例,年龄6月～6岁,体质量5.8～23 kg,X线心胸比值0.40～0.68。其中膜周部VSD 37例,肌部VSD 2例。经胸骨下端3～5肋小切口,暴露右心室表面,在TEE引导和实时监测下,穿刺右心室游离壁,建立轨道,通过短输送装置直接将封堵器安放在VSD部位。结果:37例患者封堵成功,2例改为常规体外循环下手术。置入封堵器直径4～10 mm,术后3～5 d出院,随访3～24月,无残余分流、主动脉瓣返流以及周围组织卡压等并发症。结论:应用短输送系统经胸微创非体外循环(CPB)下封堵室间隔缺损,是一种简单安全的治疗方法。

Objective： To explore the clinical experience of inimally invasive transthoracic device closure of ventricular septal defect（VSD） with a short delivery system without cardiopulmonary bypass （CPB）. Methods： The total of 39 cases of VSD were collected in the study. There were 13 males and 26 females, aged 6 months to 6 years（2.8 years＋0.8 years）,weighted 5.8 to 23 kg （14.71 kg＋ 1.98 kg）. 37 children had perimembranous VSDs, 2 had muscular VSDs. Under TEE guidance and real-time monitoring through small incision in the sternal ribs of 3 to 5, the surface of the right ventricle was exposed, by puncturing of the right ventricular free wall, the track was established, and then the occluder was placed in the VSD site through short delivery devices. Results： The closure of VSD in 37 cases with this method completed successfully,the other two cases were converted to traditional surgical closure with CPB. The diameter of occluder were 4 to 11 ram. Children were discharged 3 to 5 days after the operation. During follow-up period from 3 to 24 months,no residual shunt, aortic re- gurgitation, or the surrounding tissue entrapment happened. Conclusion： Transthoracic minimally invasive closure of VSD,without CPB by application of a short delivery system, is a simple and safe treatment method.