经胸微创介入封堵术治疗先天性心脏病的疗效

Curative effect of transthoracic minimally invasive closure without cardiopulmonary bypass for congenital heart disease

目的 探讨经胸微创介入封堵术治疗先天性心脏病的手术方式及其疗效。方法 选取80例先天性心脏病患者,男42例、女38例,年龄1~50岁,体重8~65kg,其中继发孔型房间隔缺损（ASD）25例、动脉导管未闭（PDA）13例、室间隔缺损（VSD）42例,均于全身麻醉、非体外循环、超声引导下经胸由输送器置入封堵器闭合缺损部位。结果 本组80例患者手术均获成功,平均手术时间为（65.2±13.4）min,平均术中失血量为（30.0±11.2）mL。无1例患者死亡。3例ASD患者因缺损较大,术中封堵器脱落,利用“风筝线”技术顺利取出封堵器,更换大号封堵器,经2次调整后封堵成功;其他患者均一次封堵成功。2例ASD患者术后出现肺动脉高压危象,经治疗后好转,心功能改善。所有患者平均住院时间为（5±2）d,术后平均随访时间为（18±3）个月,随访期间均无封堵器移位和残余分流发生。结论 经胸微创介入封堵术治疗先天性心脏病是一种简便和安全有效的方法。

Objective To investigate the operative technique and curative effects of transthoracic minimally invasive closure for congenital heart disease without cardiopulmonary bypass. Methods Eighty patients with congenital heart disease （42 males and 38 females, aged 1 -50 years, weighing 8- 65 kg） underwent ultrasound-guided transthoracic closure without cardiopulmonary bypass under general anesthesia. There were 25 cases of isolated arterial septal defect （ASD）, 13 cases of patent ductus arteriosus （PDA） and 42 cases of ventricular septal defects （VSD）. Results The operation was successfully performed in all the patients. The mean duration of the procedure was （65.2±13.4） min and the mean intraoperative blood loss was （30.0±11.2） mL. Occluders fell off in three ASD patients due to large defects, but the closure was accomplished after the replacement of larger occluders twice. Postoperative pulmonary hypertension crisis was found in two ASD patients, but the heart function was improved after treatment. The mean hospital day was （5± 2） d. During a mean follow up of （18±3） months, no movement of occluders or residual shunt occurred. Conclusion The transthoracic closure is a simple, safe and effective intervention for congenital heart disease. （Shanghai Med J, 2015, 38= 811-814）