食管超声引导下先天性房/室间隔缺损封堵188例的效果及影响因素分析

Influencing factors and outcomes of atrial septal defect or ventricular septal defect occlusion guided by echocardiography

目的分析食管超声引导下房间隔缺损(ASD)及室间隔缺损(VSD)封堵的临床效果及影响因素。方法回顾性分析我科2009年7月至2017年7月188例在食管超声引导下经胸和经皮封堵的ASD和VSD患者的临床资料,其中男74例、女114例,年龄1～65(13.48±13.53)岁。结果 ASD经胸封堵53例,封堵困难4例,封堵失败6例;经皮封堵24例,封堵困难3例,封堵失败1例。VSD经胸封堵108例,封堵困难10例,封堵失败5例;经皮封堵9例,封堵失败后改经胸封堵5例。分析显示,孔径过大/小是ASD经胸/经皮封堵的影响因素,两种封堵途径对此各有优劣;VSD特殊类型是经胸封堵的影响因素,技术改良前后效果差异显著。结论当ASD孔径≥25 mm时最好选用经胸封堵以避免使用过大封堵器;孔径<25 mm时,最好选用经皮封堵;孔径≥35 mm最好放弃封堵;干下型VSD通过技术改良可显著提高封堵效率,入口径>10 mm膜部瘤多破口者应避免封堵。

Objective To analyze the influencing factors and outcomes of atrial septal defect(ASD) and ventricular septal defect(VSD) occlusion guided by echocardiography. Methods We retrospectively analyzed the clinical data of 188 patients receiving transthoracic and percutaneous transcatheter closure of ASD and VSD from July2009 to July 2017 in our department, including 74 males and 114 females, aged 13.48±13.53 years ranging from 1 to 65 years. Results Fifty-three ASD patients accepted transthoracic closure surgery, of whom 4 patients were difficult to close and 6 patients failed to close; 24 patients underwent percutaneous transcatheter ASD occlusion surgery, of whom 3 were difficult to close and 1 failed in occlusion; 108 VSD patients implemented transthoracic closure surgery, of whom 10 patients were difficult to close and 5 patients failed in closure; 9 VSD patients underwent percutaneous transcatheter closure, of whom 5 failed and then was converted to transthoracic closure. Our study showed that too large or too small aperture was the independent risk factor. Two kinds of closure surgery had their own advantages and disadvantages. The special type of VSD was the influencing factor of transthoracic closure. Conclusion When the ASD diameter≥25 mm,transthoracic closure is the best choice to avoid the use of large occluder. When the ASD diameter<25 mm, percutaneous closure surgery is the best choice. When the ASD diameter≥35 mm, it is best to give up the closure operation. Technical improvements can significantly raise the closure success rate of the subarterial VSD. For the entry diameter>10 mm and membranous aneurysm with multi-break, occlusion surgery should be avoided in VSD.