Amplatzer第Ⅱ代血管塞封堵膜周型室间隔缺损的临床应用

The clinical application of Amplatzer vascular plug Ⅱ in treating perimembraneous ventricular septal defects

目的：探讨应用Amplatzer第Ⅱ代血管塞介入治疗膜周型室间隔缺损（VSD）的可行性。方法5例膜周型VSD患儿均采用Amplatzer第Ⅱ代血管塞进行封堵。封堵后行左心室、升主动脉造影以及心脏彩色多普勒超声（彩超）检查评价疗效，术后24 h和1、3、6个月进行心电图、心脏彩超随访观察。结果心脏超声及左心室造影示膜周型VSD，左室面6.4~9.0 mm，部分假性室隔瘤形成，右室面分流口为2.1~2.9 mm，VSD上缘距主动脉瓣2.1~3.8 mm。每例患儿均置入1枚Amplatzer第Ⅱ代血管塞，置入的血管塞直径为4～10 mm，平均（6.8＆#177;2.3） mm。术毕即刻造影检查和超声心动图检查示1例患儿装置下缘存在细丝残余分流，术后1个月复查时残余分流消失。其余患儿封堵器位置、形态良好，无残余分流。所有患儿心电图检查均为窦性心律，无新出现的房室传导阻滞或束支传导阻滞。结论 Amplatzer第Ⅱ代血管塞可用于一些特殊类型尤其是伴有长管状的假性室隔瘤形成的VSD的介入治疗，操作简便，成功率高、安全性好。

Objective To discuss the feasibility of using Amplatzer vascular plug Ⅱ to occlude perimembraneous ventricular septal defects （VSD）. Methods Transcatheter closure by using Amplatzer vascular plugⅡwas carried out in 5 patients with perimembraneous VSD. The patients included 3 girls and 2 boys, with a mean age of （3.8 ＆#177; 1.3） years （ranged 3-6 years） and a body weight of （11.8-22.0） kg. The vascular plug was released after its position was confirmed by angiography and echocardiography. After the treatment, left ventricular and aortic angiography as well as color echocardiography was performed to evaluate the therapeutic results. Each patient underwent electrocardiographic and echocardiographic examination at 24 hours after closure, at the time of discharge from the hospital, and at 1, 3, 6 month during the follow-up period. The results were analyzed. Results The echocardiogram and angiogram showed that the diameter of VSD was 6.4 - 9.0 mm in the left ventricle side with an aneurysmal transformation and was 2.1 - 2.9 mm in the right ventricle side. The distance from the upper rim of VSD to aortic valve was 2.1 - 3.8 mm. Transcatheter deployment of the device was successfully accomplished in all patients. The size of deployed device ranged from 4 to 10 mm. Angiogram and echocardiogram revealed that the defect was successfully occluded in all patients except one who showed a trivial residual shunt at the lower rim of the device, and the residual shunt disappeared one month later. During follow-up period, no patient developed bundle branch block or atrioventricular block. The position of the device remained stable. Conclusion Transcatheter closure＆amp;nbsp;of perimembranous ventricular septal defects, especially in the patients with long-tube type aneurysmal transformation, the use of Amplatzer vascular plug Ⅱ as the occluder is safe and effective.（J Intervent Radiol, 2014, 23：284-287）.