并发中、重度三尖瓣返流的膜周型室间隔缺损行介入封堵的可行性

Feasibility of transcatheter occlusion of perimembranous ventricular septal defect accompanied by tricuspid insufficiency

目的:研究介入封堵术对并发中、重度三尖瓣返流的膜周型室间隔缺损的治疗效果。方法:选取并发中、重度三尖瓣返流的膜周型室间隔缺损患者42例,三尖瓣返流的原因为右室局部心腔压力增高所致的高压血流直接冲击三尖瓣及其腱索而导致三尖瓣返流,其中行导管介入封堵20例(介入封堵组),外科修补手术22例(外科手术组)。比较两组患者术后三尖瓣返流程度(三尖瓣返流长度、三尖瓣返流面积、三尖瓣返流容积、三尖瓣返流速度、三尖瓣返流压差)、手术成功率、并发症发生率、术后住院时间、住院总费用、手术时间、正性肌力药物评分、术后第24 h白细胞计数、C反应蛋白(CRP)、心肌损伤标志物(cTnI、CK-MB、MYO)。结果:术后三尖瓣返流量较术前显著减少。两组手术方式后的三尖瓣返流程度无统计学差异。导管介入组在手术时间、术后血管活性药物、术后第24 h白细胞计数、CRP、心肌损伤标记物方面均优于外科手术组。在手术费用方面外科手术组略低于导管介入组。手术住院天数、并发症发生率两者无显著差异。结论:术前经过认真的超声评估,部分室间隔缺损并发三尖瓣中、重度返流的患者行介入治疗优于外科手术。

AIM：To study the effectiveness of transcatheter occlusion in patients with perimembranous ventricular septal defect （VSD） accompanied by tricuspid valve insufficiency （TI）. METHODS： Fortytwo patients with perimembranous VSD accompanied by TI were included in the study. TI was caused by the bloodstream through ventricular septum impact tricuspid valve and chordae tendineae. Patients were randomly divided into two groups：group A （n=20） was treated with occluder implantation and group B was treated with surgery （n=22）.The severity of TI, success rate of surgery, rate of complications, hospital stay after operation,total hospitalization expenses, mean operation time, inotropic score, white blood cell count,C-reactive protein and markers for serum myocardial damage in the two groups were compared. RESULTS：TI was alleviated after operation in both groups and no statistically difference in TI severity after operation was found between groups. Mean operation time, inotropic score, white blood cell count,C-reactive protein and markers for serum myocardial damage in group A were better than those in group B.Total hospitalization expenses in group A were lower than in group B and no statistically significant difference between groups was seen in regard to the success rate of surgery, rate of complications, and hospital stay after operation. CONCLUSION： After echocardiography assessment, transcatheter occluder implantation is superior than surgery for some patients with perimembranous VSD accompanied by TI.