单纯超声引导下经颈静脉室间隔缺损封堵术的探索研究

Exploration Research of Ventricular Septal Defect Closure via Trans-jugular Approach Solely Under the Guidance of Echocardiography

目的：为了避免放射线及对比剂的损伤，扩展超声引导经皮室间隔缺损（VSD）封堵术的应用范围，在经股动脉封堵VSD的基础上，探讨使用单纯超声引导下进行经颈静脉VSD封堵术的有效性和安全性。方法：2014-10至2015-04，入选先天性膜周型VSD患者12例，年龄1.2-3．5岁，平均（2．4±0．8）岁，体质量7-15kg，平均（11．6±2．6）kg，VSD直径3．5-6．0mm，平均（4．8±0．7）mm。患者在经食道超声引导下经颈静脉行VSD封堵术，封堵后以超声检查评价治疗效果。术后1、3、6个月在门诊随访。结果：9例患者成功经食道超声引导下完成经颈静脉VSD介入封堵术。1例患者因导丝未能通过VSD，改为经股动脉封堵成功；1例患者因导管未能沿导丝通过VSD，改超声引导下经胸小切口封堵成功；1例患者因残余分流大于2mm，改常规外科手术治疗成功。手术时间为53-89min，平均（67．2±12．5）min。对称型VSD封堵器直径6-8mm，平均（7．0±0．9）mm。术后即刻微量残余分流2例。所有患者康复出院，无外周血管损伤及心包填塞等并发症。住院时间为3-5d，平均（3．6±0．7）d。术后平均随访时间1-6个月，平均（3．9±2．1）个月，随访1个月时2例患者微量残余分流消失，患者均未出现心包积液、封堵器脱落、主动脉瓣反流、房室传导阻滞等并发症。结论：单纯超声引导下经颈静脉途径封堵低龄VSD患者安全、有效，而且能避免使用放射线和对比剂。

Objective： In order to avoid the radiation and contrast agent injury, and to extend the echocardiography guided percutaneous ventricular septal defects （VSD） closure, based on femoral artery approach, we assessed the efficacy and safety of VSD closure via trans-jugular approach solely under the guidance of echocardiography. Methods： A total of 12 patients with peri-membranous VSD treated in our hospital from 2014-10 to 2015-04 were enrolled. The patients were at the age at （1.2-3.5 with the mean of 2.4±0.8 ） years, the body weight at （7-15 with the mean of 11.6±2.6） kg and the diameter of VSD was （3.5-6 with the mean of 4.8±0.7） mm. The patients received percutaneous VSD closure via transjugular approach solely under the guidance of echocardiography. The procedural effect was evaluated by echocardiography and the follow-up study was conducted at 1, 3 and 6 month safter the procedures. Results： There were 9 patients successfully finished VSD closure via trans-jugular approach. 1 patient was converted to femoral artery approach because the wire could not pass through the defect of ventricular septal; 1 was converted to minimally invasive per-ventricular closure since the catheter could not pass through the defect; 1 was converted to conventional surgical repair due to the residual shunt was more than 2mm. The procedural time was （53-89 with the mean of 67.2±12.5） min, the diameter of symmetrical occluder was （6-8 with the mean of 7.0±0.9） ram. 2 patients had immediate post-operative residual shunt, all patients were recovered and discharged. No peripheral vascular injury and cardiac perforation occurred, the hospitalization time was （3-5 with the mean of 3.6 ± 0.7） days. The follow-up examination was conducted at （1-6 with the mean of 3.9±2.1） months, the slight residual shunt in 2 patients disappeared at I month after procedure; no pericardial effusion, occluder malposition, aortic regurgitation and atria-ventricular block occurred. Conclusion： Echocardiography guided trans-jugular approach of VSD closure is safe and effective, it may particularly avoid the radiation and contrast agent injury in clinical practice.