应用Amplazter封堵器治疗膜周部室间隔缺损的进展

Progress of application of Amplatzer occluders in transcatheter closure of perimembranous ventricular septal defect

膜周部室间隔缺损(室缺)是最常见的先天性心脏病。自从本世纪初Amplatzer膜周型封堵器被广泛应用于膜周部室缺介入封堵治疗。同时新型改良设计的Amplatzer封堵器陆续问世,以及多种Amplazter封堵器非常规应用于膜周部室缺封堵,并开展了大量的临床应用研究。目前由于应用初代Amplatzer膜周型封堵器后近期或远期完全性房室传导阻滞并发症发生率较高,许多中心放弃了对其继续研究应用。对于完全性房室阻滞的机制深入探究以及封堵器选择应用进一步优化,将使Amplatzer封堵器在临床中具有广泛的应用空间,并为膜周部室缺的介入封堵治疗提供了新的思路。

Perimembranous ventricular septal defects （pmVSDs） are the most common congenital heart disease. Since the early 2000 s, Amplatzer pmVSD occluder （AGA Medical, Golden Valley, MN, USA） has been widely used in transcatheter procedures for closure of pmVSDs. Recently, clinical trials with modified Amplatzer occludcr and other new devices have demonstrated promising results in initial studies. Unfortunately, many medical centers have abandoned the first-generation Amplatzer pmVSD occluders due to their unacceptably high risk of postprocedural and late-onset complete atrioventricular block （cAVB）. However, study of the mechanism of cAVB and further optimal selection of occluders will provide a new approach for application of Amplatzer occluders in transcatheter closure of pmVSDs.