经导管国产封堵器介入治疗膜周部室间隔缺损患儿的疗效随访

Follow-up of transcatheter closure of perimembranous ventricular septal defect children with modified doubel-disk occluder device

目的随访观察经导管国产封堵器介入治疗膜周部室间隔缺损（PMVSD）患儿的疗效及并发症。方法选择2011年7月-2014年12月该院使用国产封堵器行介入治疗的PMVSD患儿52例,所有患儿在X线透视及超声下行室间隔缺损（VSD）封堵术治疗,术后即刻行左心室、升主动脉造影,超声心动图评价治疗效果。术后1d、1、3、6、12及24个月及以后每隔1年定期复查,评价短期及中远期疗效,包括经胸超声心动图评价分流和返流情况,心脏大小及心功能情况。同时行心电图检查观察有无心律失常。结果①48例患儿治疗成功,4例未能封堵成功,手术成功率92.31%。②对48例患儿进行了临床随访,中位随访时间23.6个月（12-48个月）。其中,4例患者术后1d存在微量或少量残余分流,即刻残余分流率8.33%,术后残余分流量逐渐减少,术后1个月2例分流完全消失,2例仍存在微量或少量分流,残余分流率4.17%。6例患儿出现传导阻滞,其中右束支传导阻滞5例,左束支传导阻滞1例。1例患儿出现交界性室性异搏心率,心律失常发生率为14.58%。术后24个月新出现微量或少量返流2例,无封堵器脱落、血栓栓塞、感染性心内膜炎或猝死等。③患儿术后12和24个月的心脏大小均较术后1 d增大（P〈0.05）,但均在正常范围内。而术后12个月、24个月、术后1 d与术前的心功能比较差异无统计学意义（P〉0.05）。结论经导管国产封堵器介入治疗小儿膜周部室间隔缺损成功率较高,术后并发症发生率低,中远期疗效确切,值得临床推广应用。

Objective To follow up effect of the transcatheter closure of perimembranous ventricular septal defect（PMVSD） children with modified doubel-disk occluder device. Methods 52 cases of PMVSD children who received interventional treatment using domestic occluder monitored by X-ray and ultrasound from July 2011 to December2014 were analyzed. The therapeutic effects were evaluated immediately after the implantation by angiography of left ventricular and aortic,and ultrasound cardiogram. 1 days,1 month,3 months,6 months,12 months,24 months follow-ups were performed to evaluate the short-term,mid-term and long-term efficacy,in which transthoracic echocardiography was used to diagnosis of shunt and regurgitation and to detect cardiac size and function,and electrocardiogram was performed to inspect the. Arrhythmia. Results Of the 48 successfully treated patients,4 cases failed to be implanted,the success rate was 92.31%. Follow-up of 48 patients were completed,and the median follow-up time was 23.6 months（12-48 months）. Postoperative trace or small residual shunt immediately were found in4 patients so that the residual shunt rate was 8.33 %. Then postoperative residual volume reduced gradually1 months later,2 cases of shunt disappeared completely,but there were still 2 cases existing small quantity residual,and the residual shunt flow rate was 4.17%. There were totally 6 cases of atrioventricular block,5 of which suggested right bundle branch block,and with 1 case having left bundle branch block and with 1 case occurring borderline idioventricular rhythm. The incidence of arrhythmia was 14.58 %. There were 2 new cases of trace or a small amount of reflux. No shedding of occluder,infective endocarditis,and thromboembolism occurred. The cardiac size on postoperative 12 month and 24 month significantly increased compared with that of 1 day（P〈0.05）,which were within the normal range. The cardiac function on postoperative 12 month,24 month and1 day were found no significantly difference to the preoperative condition（P〉0.05）. Conclusion Transcatheter domestic occluder in transcatheter closure of perimembranous ventricular septal defect in children was successful at a comparatively high rate,and appeared a low incidence of postoperative complications,and the long-term curative effect was reliable,worthy of clinical application.