微创经胸小切口室间隔缺损封堵术临床分析

Clinical application value of intraoperative device closure of through a minimal inferior median incision

目的 总结微创经胸骨下段小切口室间隔缺损（VSD）封堵术的临床应用.方法 分析我院心脏大血管外科2011年5月至2015年12月经胸骨下段小切口微创封堵术治疗VSD的患者86例.术前行经胸超声心动图评估筛选适合封堵的VSD患者;术中行经食管超声心动图再次评估VSD是否适合封堵治疗,并确定封堵器型号,引导封堵器释放,评判封堵效果.出院后对患者进行随访.结果 86例VSD患者中84例成功封堵,成功率97.67％,2例封堵不成功转体外循环下修补.随访6～24个月,无残余漏,心功能改善.结论 经胸及经食管超声心动图配合下,经胸骨下段小切口微创封堵VSD技术不需要体外循环辅助,是一种简单、安全、有效的治疗方法.

Objective To therapy the ventficular septal defect（VSD） much more better, we analyzed and summarized clinical application value of intraoperative device closure of through a minimal inferior median incision guided by transthoraeic eehocardiography （TTE）. Methods 86 patients underwent this procedure were enrolled in the study from May 2011 to December 2015. A minimal inferior median incision was performed after full evaluation of the VSD by realtime rITE, and a domestically made device was inserted to occlude the VSD. The size of the oc- eluder was determined by means of transthoracic echocardiographie analysis. Results Implantation was ultimately successful in 86 patients, 2 patients were converted to surgical repair under cardiopulmonary bypass. 84 eases have no residual shunt and their heart function was improved after operation during the 6-24 months follow-up periods. Conclusion Guided by transesophageal eehocardiography, minimally invasive transthoracic device closure of VSD without cardiopulmonary bypass is a safe, feasible and effective therapy.