国产封堵器治疗嵴内型室间隔缺损的近远期效果观察

Efficacy and long-term follow-up of interventional treatment by using demostic occluder of intracristal ventricular septal defect

目的：探讨应用国产封堵器经导管介入封堵治疗嵴内型室间隔缺损（ intracristal ventricular septal defect，IVSD）的近期及远期效果。方法2005-07至2010-12经超声心动图初诊43例IVSD患者，男24例，年龄3～21岁，女19例，年龄10～28岁，超声测量直径平均（4．5±2．8） mm（3～8 mm）。按常规方法建立股动脉-室间隔-股静脉的轨道行介入治疗，选用国产封堵器治疗。结果43例患者最终确诊为IVSD，其中有2例转心外科治疗，1例合并主动脉缩窄，另1例合并右室流出道狭窄。有3例介入手术未成功，成功封堵的38例中术后有3例主动脉瓣微量反流，随访平均6．5年（4～9年），期间仍有1例患者主动脉瓣微量分流。封堵器无移位，无心律失常。结论国产封堵器介入治疗嵴内型室间隔缺损效果肯定，成功率高，残余分流及封堵器移位发生率低，远期随访疗效可靠。

Objective To assess the efficacy and long-term effect in interventional treatment of intracristal ventricular septal defect（IVSD）.Methods Forty-three patients with IVSD confirmed by echocardiography were recruited, of whom 24 men with the age ranging from 3-21 and 19 women with the age ranging from 10-28years.The diameters of IVSD measured by echocardiography ranged 3-8 mm [mean（4.5 ±2.8） mm].The arteria cruralis-interventricular septal defect-femoral vein track was occluder established under the left ventricular and ascending arortic angiography,was used by demostic plugging device.Results Of all patients, the defects in 38 patients were successfully occluded, showing that the left to right shunt disappeared and minimal aortic valve regurgitation occurred only in three patients after the procedure.The occluders were not removed and cardiac arrhythmia did not occur after 4-9 years follow-up.Three of them were unsuccessful.Two patients underwent surgical operation, because they not only had ventricular septal defect but also had aortic coarctation or right ventricular outflow tract stenosis.Conclusions Interventional treatment of intracristal ventricu-lar septal defect without combined right coronet valve severe prolapse and severe aortic valve regurgitation is an effective and safe meth-od.The effect of demostic plugging device is good.Following indications strictly, the near term and long term effect are reliable.