心内直视下镶嵌治疗肌部室间隔缺损

Hybrid procedure under direct vision for muscular ventricular septal defects

目的 探讨心内直视下镶嵌治疗肌部室间隔缺损（mVSD）的手术方法及临床疗效.方法 2008年1月至2013年7月,在体外循环心内直视下镶嵌治疗肌部室间隔缺损29例,男19例,女10例,年龄2个月～7岁;其中单个肌部室间隔缺损7例,多发室间隔缺损22例.合并法洛四联症5例,完全性大血管转位1例,肺动脉瓣狭窄3例,房间隔缺损6例,主动脉缩窄3例.合并心脏畸形均同期手术纠治.结果 死亡2例,死亡率6.9％.术后随访3个月～3年,无远期死亡,封堵器边缘少量残余分流3例,无封堵器偏移、二尖瓣反流、主动脉瓣反流、Ⅲ度房室传导阻滞.结论 心内直视下镶嵌治疗肌部室间隔缺损是一种安全、简便、有效的方法.

Objectives To summarize the technique and clinical outcomes of hybrid procedure under direct vision for muscular ventricular septal defects （mVSD）. Methods From January 2008 to July 2013, 29 cases of mVSD underwent hybrid procedure with cardiopulmonary bypass （CPB）. Muscular ventricular septal defects were closed with devices under direct vision. Of these patients, there were 19 males and 10 females, aged 2 months to 7 years. Seven patients had one muscular ventricular septal defect and 22 patients had multiple ventricular septal defects. Eighteen patients had other congenital heart diseases, including tetralogy of Fallot in 5 cases, transposition of the great arteries in 1 case, pulmonary artery stenosis in 3 cases, atrial septal defect in 6 cases and aortic coarctation in 3 cases. The other corrections of cardiac malformation were performed at the same time. Results Two patients died, with the mortality of 6.9%. In the follow-up of 3 months to 3 years, no death occurred. Small residual shunt took place in 3 patients. There was no incidence of migration of devices, atrioventricular valve dysfunction, aortic regurgitation, Ⅲ °atrioventricular conduction block or new arrhythmia. Conclusions Hybrid procedure under direct vision for muscular ventricular septal defects is convenient, safe and effective.