超声引导下经胸室间隔缺损封堵不顺利/失败病例分析

Analysis of difficult or failed cases of transthoracic closure ventricular septal defect under ultrasound guidance

目的 分析超声心动图引导下经胸室间隔缺损(ventricular septal defect,VSD)封堵不顺利和(或)失败的原因及其对策.方法 对2009年7月至2017年7月我院经胸VSD封堵108例病例进行分析,其中男性45例、女性63例,年龄1~57岁,平均(9.1±9.7)岁,体重8~85kg,平均(25.2±17.6)kg.膜周型VSD 41例,VSD伴膜部瘤形成30例,出口直径≤2.5 mm者9例,干下型VSD 28例;对其中封堵不顺利10例和封堵失败5例进行回顾性分析.结果 5例VSD入口直径>10mm的膜部瘤多个出口者中封堵不顺利2例,封堵失败2例;15例膜部瘤多个出口、入口直径≤10mm者封堵不顺利1例;28例干下型VSD中封堵不顺利7例(均发生在2013年12月以前),封堵失败2例;9例出口径≤2.5 mm者中首例封堵失败.结论 VSD入口直径>10mm的膜部瘤多出口者经胸封堵较为困难,失败率较高,在无特殊形态封堵伞产品出现之前应避免进行封堵治疗;干下型VSD、小孔径VSD以及膜部瘤形成多个出口、入口直径≤10mm者通过技术改良可显著提高封堵效率和成功率.

To anlysis the causes and countermeasures of difficult or failed cases of transthoracic ventricular septal defect under ultrasound guidance. Method:From July 2009 to July 2017, 108 patients with VSD were treated with transthoracic closure. There were 45 males and 63 females, aged 1-57 years (mean 9.1±9.7 years), weighing 8-85 kg (mean 25.2±17.6 kg). A retrospective analysis was performed on 10 cases who were difficult and 5 cases who failed to block. Result:5 cases of Multiple exportation of Ventricular Septal Aneurysm with an inlet diameter >10mm were difficult to block in 2 cases, and 2 cases were failed. 15 cases of Multiple exportation of Ventricular Septal Aneurysm with inlet diameter ≤10mm were faied to block. In 28 cases of subarterial ventricular septal defect , 7 cases were difficulty blocked,all of them occurred before 12.2013, and 2 cases failed to be occluded. The first case of 9 cases with an exit diameter of ≤2.5mm failed. Conclusion:The Multiple exportation of Ventricular Septal Aneurysm with an inlet diameter >10mm is difficult to block through transthoracic, the failure rate is higher. Before no special form occluder products appear transcatheter therapy should be avoided. subarterial ventricular septal defect, Small aperture ventricular septal defect, Multiple exportation of Ventricular Septal Aneurysm and inlet diameter ≤10mm can significantly improve plugging efficiency and success rate through technical improvement.