婴幼儿室间隔缺损184例经导管介入治疗回顾分析

Feasibility and safety of transcatheter closure of ventricular septal defects in 184 children under 3 years old

目的评价经导管介入方法治疗小年龄儿童室间隔缺损的临床疗效。方法回顾性分析2011年1月至2012年12月于广东省心血管病研究所行室间隔缺损封堵术3岁以下患儿的临床资料、疗效及随访结果。结果共184例患儿,176例(95.7%)封堵成功,所有病例均无血管并发症发生,13例术后存在微-少量残余分流,2例出现三尖瓣血流速度增快,1例于术后半年出现迟发型Ⅲ度房室传导阻滞。结论小年龄儿童室间隔缺损的经导管介入治疗成功率高,其安全性有待长期随访观察,严格掌握介入封堵适应证、选择合适的器械、熟练掌握婴幼儿血管穿刺技术、良好的麻醉管理是手术成功的关键。

Objective To evaluate the clinical effect of transcatheter closure for ventricular septal defect in infants and young children. Methods Clinical data from 184 children under 3 years old who underwent the transcatheter VSD closure from Jan. 2011 to Dec. 2012 were analyzed. Results Procedure was successful in 176 cases （95.7%）. No death occurred, residual shunt in 13 cases, tricuspid inflow accelerated in 2 cases, late-onset complete atriovenous block in one case （6 months after procedure）. All cases had no vascular complications. Conclusion Transcatheter closures for ventricular septal defects are effective in small children. Long-term follow-up is needed to evaluate the safety of this operation. The keys to the success of operation are the proper indications,suitable apparatus,skillful vascular punction and good anaesthetic management.