膜部瘤型室间隔缺损介入封堵个体化治疗方案分析

Individualized therapeutic scheme of transcatheter closure for aneurysm-like perimembranous ventricular septal defects

目的探讨不同类型膜部瘤型室间隔缺损介入封堵术的个体化治疗方案。方法膜部瘤型室间隔缺损患儿47例,依据经胸超声心动图检查、左心室及主动脉瓣上造影进行诊断分型,然后行介入封堵术。结果 46例(97.9%)介入治疗成功,1例(2.1%)介入治疗失败;2例术后存在少量残余分流;1例术后出现三尖瓣轻-中度反流,未行特殊处理,术后3个月经胸超声心动图复查三尖瓣功能恢复正常;患儿均未发生膜部瘤破裂、封堵器脱落、持续溶血、房室传导阻滞及主动脉瓣反流等术后并发症。结论介入封堵术治疗膜部瘤型室间隔缺损安全、有效,采用正确个体化介入封堵方案可进一步提高治疗成功率。

Objective To explore the individualized therapeutic scheme of transcatheter closure for different types of aneurysm-like perimemhranous ventricular septal defect （VSD）. Methods Forty-seven patients with aneurysm-like perimembranous VSD were diagnosed by using transthoracic echocardiography and left ventricular and aortic angiography. The clinical data of transcatheter closure for different types of aneurysm-like perimembranous VSD were retrospectively analyzed. Results The transcatheter closure succeeded in 46 cases （97.9%）. And one case failed （2.1%）. Two cases had mild residual shunt. One case had mild to moderate tricuspid valve regurgitation, and transthorancic echocardiography showed the valve function returned normal without any treatment 3 months after operation. No complications occurred as ruptured aneurysm of the membranous, occluder detachment, persistent hemolysis, postoperative atrioventricular block, or aortic regurgitation. Conclusion The transcatheter closure is safe and effective for aneurysm like perimembranous VSD. The individualized therapeutic scheme of transcatheter closure can improve the successful rate.