单纯食管超声引导经股动脉逆行封堵室间隔缺损的可行性

Feasibility of retrograde approach for percutaneous closure of ventricular septal defect under solely guidance of transesophageal echocardiography

目的探讨单纯食管超声引导经股动脉逆行插管行室间隔缺损封堵术的可行性。方法人选室间隔缺损患者12例（含室间隔缺损残余漏4例），均为2015年3—10月郑州大学人民医院儿童心脏中心住院患儿，年龄（11．58±6．57）岁，体质量（31．85±13．28）kg，室间隔缺损直径（5．50±2．20）mm。患者均仅在经食管超声心动图引导下经股动脉逆行插管行室间隔缺损封堵术，术后即刻采用食管超声心动图评价手术效果，术后24h及1、3、6个月行经胸超声心动图、x线平片及心电图进行随访。结果12例患者均在单纯食管超声引导下完成VSD经皮封堵术，手术操作时间为50～100（66．0±15．4）min，封堵器型号5～14（7．08±2．35）mm，围手术期未见封堵器脱落、心包积液、瓣膜损伤返流及房室传导阻滞等并发症。术后即可1例存在微量残余分流。随访中均未见残余分流、封堵器移位、外周血管损伤及心脏穿孔等并发症。结论对于合适患者，单纯食管超声心动图引导下经股动脉逆行插管行室间隔缺损封堵术安全可行，不仅能避免放射线及对比剂损伤，又可简化操作流程。

Objective To evaluate the feasibility of retrograde transcatheter closure of ventricular septal defects （VSD） under trans-esophageal eehocardiography （TEE）. Methods Twelve patients with VSD, with 4 residual shunt, treated by transeatheter VSD closure under solely guidance of TEE were summarized. Mean age, body weight and average diameter of VSD in 12 cases were （ 11.58 ± 6. 57 ） years, （31.85 ±13.28 ） kg, （5.50± 2. 20） mm, respectively. All patients were treated by retrograde transcatheter closure under solely guidance of TEE. The post-operative efficiency was estimated by TEE immediately. Patients were followed up by eehoeardiography, X-ray examination and electrocardiogram at 24 hours, 1,3 and 6 months after the procedures. Results All 12 patients were treated successfully under solely guidance of TEE. The diameter of devices were 5 - 14 mm. There were 1 case with trivial residual shunt after the procedures immediately. No patients suffered from residual shunt, oeeluder malposition, peripheral vascular injury and pericardial effusion during the follow-up. Conclusion Pereutaneous transeatheter closure of VSD completely guided by TEE is safe and effective. This method could avoid the radiation and contrast media reaction, and also could simplify the procedure.